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The purpose of this bulletin is to inform providers that, in accordance with the Virginia Acts of Assembly 2021 Special Session I, Chapter 476, HB 2124, DMAS will reimburse for COVID testing and treatment – effective March 23, 2022 – and COVID vaccinations – effective April 6, 2022 – performed for individuals covered by Emergency Medicaid. The list of applicable codes – current as of the publication of this bulletin – are listed on p. 2 and 3 of this bulletin. Specifically:

• Inpatient claims submitted on a UB-04:
  • In cases that a COVID test, vaccination and/or treatment is included in a provider claim that DMAS determines to be an emergency service eligible for reimbursement, no additional action is needed by providers to be reimbursed for the COVID-related services.
  • In cases that a COVID test, vaccination and/or treatment is included in a claim that DMAS determines not to be an emergency service (i.e., the claim denies), DMAS will reimburse for COVID services if the provider re-submits an outpatient claim on a UB-04 with only COVID testing, vaccination and treatment line items included. The claim will be reimbursed via the current DMAS EAPG methodology.
• Outpatient claims submitted on a UB-04:
  • In cases that a COVID test, vaccination and/or treatment is included in a provider claim that DMAS determines to be an emergency service eligible for reimbursement, no additional action is needed by providers to be reimbursed for the COVID-related services.
  • In cases that a COVID test, vaccination and/or treatment is included in a claim that DMAS determines not to be an emergency service (i.e., the claim denies), DMAS will reimburse for COVID services if the provider re-submits an outpatient claim on a UB-04 with only COVID testing, vaccination and treatment line items included. The claim will be reimbursed via the current DMAS EAPG methodology.
• Other professional claims submitted on a CMS-1500:
  • DMAS will only reimburse for COVID services; providers should submit a claim with only COVID testing, vaccination and treatment line items included.