10.05.2021 – Updated COVID-19 Testing, Treatment, and Vaccine Coding Grid to include the Pfizer booster administrative code (0004A).
09.30.2021 – Published the COVID-19 Antibody Test Medical Policy.
09.24.2021 – Updated COVID-19 Testing, Treatment, and Vaccine Coding Grid to indicate that cost sharing will continue to be waved for COVID-19 treatment for Massachusetts commercial members in accordance with Massachusetts Division of Insurance Bulletin 2021-08. Added Ivermectin quantity limit information.
08.31.2021 – Updated prior authorization section for Maine Medicare Advantage members to reflect that prior authorization requirements were waived for transfers from acute care hospitals to post-acute care at non-hospital locations for dates of service on or after Aug. 31, 2021.
08.27.2021 – Updated COVID-19 Testing, Treatment, and Vaccine Coding Grid to include the latest antibody treatment codes and administrative codes for the third doses of the Moderna (0013A) and Pfizer (0003A) vaccines.
07.30.2021 – Updated page and coding grid to reflect that cost-sharing will apply for code Z03.818 (encounter for observation for suspected exposure to other biological agents ruled out). Updated coding grid to reflect reimbursement of code M0201 for at-home vaccinations for commercial members.
06.07.2021 – Updates to cost-sharing and authorization policies, effective for dates of service on or after Aug. 7, 2021.
During the public health emergency, we have adapted our policies and business operations to support our members in receiving the care and to aid our provider partners in ensuring that patients can safely access the care they need. As COVID-19 cases continue to fall and states lift emergency orders, Harvard Pilgrim Health Care is returning to many pre-pandemic operations and policies. Please see the information below — which applies to our fully insured, Medicare Advantage, Medicare Enhance, and Medicare Supplement plans, unless otherwise noted — for details on COVID-19 related practices.
Harvard Pilgrim understands the urgency of getting vaccines administered swiftly and effectively and is committed to supporting providers in this important work. We are also conducting education and outreach to our members to educate them about the known safety of COVID-19 vaccines and the importance of getting vaccinated.