Updated January 22, 2024
The COVID-19 pandemic is rapidly evolving. Molina would like to share resources and updates with our provider partners.
As the COVID-19 public health concern grows, Molina Healthcare would like to share resources with our provider partners. Our corporate Chief Medical Office (CMO) is working closely with our health plan CMOs across the country to ensure that we are prepared to assist our members and providers. We will keep this page updated with new resources as they become available.
COVID-19 Related Clinical and Billing Guidance
| ICD-10 | Description |
| B97.29 | Other coronavirus as the cause of diseases classified elsewhere |
| Z03.818 | Encounter for observation for suspected exposure to other biological agents - ruled out |
| Z20.828 | Contact with and (suspected) exposure to other viral communicable diseases |
| U07.1 | COVID-19 Confirmed Cases, virus identified. Assigned to a disease diagnosis of COVID-19 confirmed by laboratory testing. |
| U07.2 | COVID-19 Suspected/Probable cases, virus not identified. Assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available. |
| CPT | HPCS Description |
| U0001 | This code is used specifically for CDC testing laboratories |
| U0002 | This code is used for non–CDC testing laboratories |
| 87635 | This code is used for non-CDC testing laboratories (effective 3/13/2020). Provider can choose to use U0002 or 87635 |
| 86328 |
Effective 04/10/20 86328 (Immunoassay for infectious agent antibody[ies], qualitative or semiquantitative, single step method [eg, reagent strip]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)] |
| 86769 |
Effective 04/10/20 86769 (Antibody; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)] |
| U0003 |
Effective 04/14/20 U0003 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)], amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R) |
| U0004 |
Effective 04/14/20 U0004 (2019-nCoV Coronavirus, SARS-CoV-2/2019-nCov [COVID-19], any technique, multiple types or subtypes [includes all targets], non-CDC, making use of high throughput technologies as described by CMS-2020-01-R) |
| 91300 |
Effective 12/11/2020 91300 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use) |
| 0001A |
Effective 12/11/2020 0001A (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose) |
| 0002A |
Effective 12/11/2020 0002A (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose) |
| 91301 |
Effective 12/18/2020 91301 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use) |
| 0011A |
Effective 12/18/2020 0011A (Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose) |
| 0012A |
Effective 12/18/2020 0012A (Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose) |
- Molina will waive co-pays and cost share for any COVID-19 related diagnostic laboratory testing, office visits, urgent care visits and ED visits. Molina will cover the test kit for patients who meet CDC guidelines for testing, which can be done in any authorized location (excluding LabCorp or Quest sites). No prior authorization is needed for this testing.
- Visits for any other symptoms or diagnoses will continue to have co-pays and cost share. This includes other laboratory testing (besides COVID-19 testing), x-rays or add-on testing.
COVID-19 Policy
Molina Healthcare Extends COVID-19 Testing and Treatment Cost Waivers
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Provider Credentialing
Molina has options in place for temporary and expedited credentialing. Providers can email their request for provisional credentialing to: MHWIProviderNetworkManagement@MolinaHealthcare.com
- Temporary providers will not require credentialing and include:
- Covering practitioners (e.g., locum tenens)
- Providers who are not part of the network and are providing care to our members as part of a federal, state or local government emergency response team.
- Rental network practitioners who provide out-of-area care only, and members are not required or given an incentive to seek care from them.
- Practitioners who practice exclusively in free-standing facilities and provide care for organization members only because members are directed to the facility
- Practitioners who practice exclusively in an inpatient or group practice setting and provide care for members only because members are directed to the hospital or another inpatient setting or group practice
- Provisional Credentialing will be expedited and completed within 5 business days. Full credentialing will be required to be completed within 180-days of the provisional approval date.
- Recredentialing - Providers who are due to be recredentialed that have closed their office or are not able to respond to recredentialing requests will be placed on a temporary hold status.
- Site Reviews - Molina will not be conducting provider site reviews in any Molina state where Site Reviews are required as part of initial and/or recredentialing.
- Temporary providers will not require credentialing and include:
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Prior Authorizations
Molina Healthcare of Wisconsin is monitoring COVID – 19 developments on daily basis and adhering to Forward Health guidelines.
- Effective 3/12/2020, Molina Healthcare of Wisconsin will automatically extend any approved Prior Authorization (PA) request due to expire before 6/30/2020 for an additional 90 days. This does not include requests for inpatient services. PA requests currently in process will be reviewed for appropriate extensions. If changes to the current PA are needed, a request must be submitted along with supporting documentation.
- Effective 3/12/2020 for Medicaid Members only: During the COVID-19 public health emergency for WI, providers servicing Medicaid members should follow PA guidelines for medically urgent requests for Advanced Imaging services. When obtaining PA prior to rendering the service is not feasible, PA requests will be backdated when clinical documentation supports a suspected or confirmed diagnosis of COVID-19, if submitted within 14 days of the date that the service was performed.
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Telehealth/Telemedicine
Claims Submission requirements for Telehealth Services Allowed Under Temporary Telehealth Guidance:
When providing and billing Telehealth Services you are required to follow the normal guidelines established under Forward Health Topic #510. There are no changes to the claim submission requirements for Modifier GT and place of service (POS) 02 (Telehealth).
- Telemedicine services submitted with POS 02 and GT Modifier will be paid at the appropriate allowable fee
- Telemedicine services submitted with POS 02, GT Modifier and Informational Modifier 95 will be paid at the appropriate allowable fee
- Telemedicine services submitted with POS 02 and No Modifiers will be denied
- Telemedicine services submitted with POS 11 and Informational Modifier 95 will be paid at the appropriate allowable fee
- Telemedicine services submitted with POS 11 and GT Modifier will be denied
NOTE: Payment modifiers should always be billed in the first position.
Telehealth Resources
- Medicare/MMP COVID-19 Provider Notices
- Behavioral Health
- Additional Resources