At Quartz, we're doing all we can to keep you informed during this pandemic. We have several updates on extended timelines for fully insured commercial members.
Extended timelines on coverage with no out-of-pocket costs
COVID-19 viral testing:
COVID-19 antibody testing:
*Medically necessary tests include tests for members with known or suspected symptoms, known or suspected exposure, and those entering health care facilities for service.
Third-party screening tests for employment, school admission, or travel are not covered
As you can see, we cover tests ordered by a provider to meet members’ medical needs. We do not cover screening tests requested by third parties,
such as those for employment, school admission, or travel:
Extended timeline for telehealth: e-visits, video visits, virtual visits
An exception to the following: Telehealth coverage for self-funded plans is based on individual plan coverage.
To appropriately waive member cost-sharing for your patients, all provider telehealth claims must have at least one of the telehealth modifiers listed below and listed within our Telehealth Visit Guidelines.
All telemedicine claims must have at least one of these indicators:
95 - Telemedicine Service
CR - Catastrophe/Disaster Related
CS - Subject to a cost-sharing waiver for testing-related services for COVID-19
GT - Via Interactive Audio and Video Telecommunication System
GQ - Via Asynchronous Telecommunication System
GO - Telehealth Services for Diagnosis Evaluation or Treatment of Symptoms of an Acute Stroke
Traditional True Telehealth Services
Historically in-person services now provided via telehealth
POS should equal what it would have been for in-person with modifier 95 to indicate provided by telehealth
|Condition Code (UB)||DR - Disaster Related|
Quartz will provide coverage for all CPT-identified telemedicine codes and codes published by CMS for fee-for-service Medicare. (Note that ASO customers will make their own member cost-sharing decisions.)
Please follow Wisconsin Forward Health coding guidelines.
Visit the ForwardHealth telehealth billing flow chart for BadgerCare Plus members.