IMPORTANT UPDATE

Valued Western Sky Providers,

As an integral partner of Western Sky, we want to keep you updated with the latest information around the novel

coronavirus and its resulting illness COVID-19. We appreciate your partnership during this time of great need as

we focus on our shared goal of delivering quality, accessible, and affordable healthcare to our members.

Western Sky is closely monitoring and following all guidance from the Centers for Medicare and Medicaid

(CMS) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of

COVID-19. As of March 25, 2020, the following below can be used to bill for services related to COVID-19 testing.

HCPCS Codes for COVID-19 Testing Services

• Western Sky is asking that all COVID-19 related claims have the phrase ‘COVID-19’ in box 23 on

CMS1500 forms, in place of the authorization number. This will be used for tracking and to allow for

quicker processing.

• Starting April 1st, 2020, providers performing the COVID-19 test can begin billing Western Sky for

services that occurred after February 4, 2020, using the following newly created HCPCS codes:

o U0001 – For CDC developed tests only – 2019-nCoV Real-Time RT-PCR Diagnostic Panel.

o U0002 – For all other commercially available tests – 2019-nCoV Real-Time RT-PCR Diagnostic

Panel.

o Code (87635) effective March 13, 2020 and issued as “the industry standard for reporting of

novel coronavirus tests across the nation’s health care system.”

o Please note: It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for

non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin

accepting starting April 1, 2020.

• All cost share (co-pay, coinsurance, and deductible) will be waived across all products for any claim

billed with the new COVID-19 testing codes.

• Western Sky has configured its systems to apply $0 member liability for those claims submitted utilizing

these new COVID-19 testing codes.

• In addition to cost share, authorization requirements will be waived for any claim that is received with

these specified codes.

• Providers billing with these codes will not be limited by provider type and can be both participating and

non-participating.

• Adjudication of claims is currently planned for the first week of April 2020.

Reimbursement Rates for COVID-19 Testing Services for ALL Provider Types

• Western Sky is complying with the rates published on March 12, 2020 by CMS for Medicare:

o U0001 = $35.91

o U0002 = $51.31

• Western Sky is complying with the rates published on March 18, 2020 by HSD for Medicaid:

o U0001 = $35.92

o U0002 = $51.33

• Western Sky will reimburse Code 87635 at the published rate for U0002 until such time as a rate is

published for 87635.

• Any additional rates will be determined by further CMS and/or state-specific guidance and communicated

when available.

Again, we thank you for your commitment to the care and wellbeing of our members, as well as to the

communities we share. Please don’t hesitate to reach out to Provider Services at 1-844-738-5019 with any

questions you may have.

Sincerely,

Western Sky Provider Relations

5300 Homestead Rd NE

Albuquerque, NM 87110

WesternSkyCommunityCare.com

About Western Sky Community Care

Established to deliver quality healthcare in the state of New Mexico through local, regional and community-based resources, Western Sky Community Care is a Managed Care Organization and subsidiary of Centene Corporation (Centene). Western Sky Community Care exists to improve the health of its beneficiaries through focused, compassionate and coordinated care. Our approach is based on the core belief that quality healthcare is best delivered locally. Learn More