This document is intended to answer the most common benefit and coding questions we’ve received from our provider community in response to the COVID-19 pandemic. Statements in this document address the most urgent needs of our provider community. This FAQ will be updated as additional information is available.

Q.        Is PacificSource covering the cost of COVID-19 diagnosing and tests with no member cost share (deductible, coinsurance, copay)?

A.        Yes, PacificSource is covering the cost of COVID-19 testing performed by in network providers with no member cost share.

Tests provided by out of network providers will be paid at the same benefit as our in-network benefit.

Q.        What HCPCS/CPT codes should be billed for COVID-19 test?

A.        Please use the following codes to report COVID-19 laboratory tests

Q. Should I administer the COVID-19 test to any of my patients who request it?

A. No. As with all medically necessary services, patients should present with appropriate signs and symptoms prior to being considered for COVID-19 testing. Tests should be administered to those who meet your screening protocol.

Q.        Is PacificSource covering any other COVID-19 related services with no member cost share?

A.        PacificSource is waiving member out-of-pocket costs for COVID-19 testing and diagnosis-related office visits, urgent care visits, telemedicine visits, ER visits, testing and radiology if billed with one of the COVID DX codes. PacificSource providers are instructed to not collect copay/coinsurance or deductibles for visiting and testing services. Other services not specified above will adhere to the member’s cost share under their standard benefit.

Services provided by out of network providers will be paid at the same benefit as our in-network benefit.

A.        Telehealth or Telemedicine–refers to consultations with a qualified healthcare professional provided in real-time over an electronic mechanism. These services are rendered to patients using electronic communications such as telephone, online audio and/or video conferencing.

Q.        Given the broad range of services for which patients may need telehealth coverage and the various mediums for telehealth delivery, how can I indicate telehealth services on my claim?

A.        Professional claims for telehealth services should be submitted with a Place of Service code ‘02’ on your claim. Modifier GT is also recognized, but not required. Facility claims for telehealth services should be submitted with a Modifier GT to identify the claim as a telehealth service.

Q.        Are self-insured companies offering the same benefits through PacificSource to their members?

A.        Self-insured companies determine if they will provide the same benefit that PacificSource is providing for fully insured groups. Most of our self-insured groups have decided to provide the same benefits. Providers can contact PacificSource Customer Service for questions about specific groups.

Q.        What is PacificSource doing to ensure access to medications for your members?

1. PacificSource is taking additional steps support our members fillingprescriptions, including:

• PacificSource is increasing access prescription medications by waiving early medication refill limits 30-day prescription maintenance medications (consistent with a member’s benefitplan)

• PacificSourceisencouragingmemberstoadvantageoftheirabilityobtaina 90-day prescription supply via mail order approved retail pharmacies.

Q.        How do I know if a service or medication requires a prior authorization?

A.        To determine if a service and or medication requires preauthorization, consult our Prior Authorization Grid (https://authgrid.pacificsource.com/). If the service requires preauthorization when done in-person, then preauthorization is required when done as telehealth. Medication coverage status and prior authorization requirements by line of business can be found here:

Commercial: https://pacificsource.com/drug-list/

Medicare Advantage: https://medicare.pacificsource.com/Search/Drug Medicaid: https://communitysolutions.pacificsource.com/Search/Drug

Q.        How do I know if a service is covered under the Oregon Health Plan (OHP)?

A.        This can be identified by using LineFinder. LineFinder is an online tool to assist providers in determining what is covered by OHP. OHP generally updates the information quarterly. (https://intouch.pacificsource.com/LineFinder)

Q.        Who can I contact if I have additional questions about PacificSource’s coverage of my COVID-19 related services or other needs during this pandemic?

1. Our Provider Service Team stands ready talk through your concerns. can contact us

• Idaho and Montana: (541) 246-1459, toll-free (855)247-7579

• Oregon and Washington: (541) 246-1457, toll-free (855)247-7575

Resources: CMS Fact Sheet Medicare FAQ OHA Fact Sheet CMS Provider Quality Reporting FAQ