Premera Blue Cross and its subsidiaries have made a determination to follow Centers for Medicare & Medicaid Services guidelines, and have been allowing for separate reimbursement for PPE over the past several months when billed appropriately. Premera will be following this practice through the end of October 2020. Below is guidance on this policy provided by the Washington State Medical Group Management Association.

Premera didn’t send out specific guidance regarding the payment for PPE, but was paying if billed using the appropriate HCPCS codes for miscellaneous supplies. This policy applies to dates of service on or before Nov. 1.

  • For dates of service on or after Nov. 1, Premera will consider such supplies to be included in the standard office visit reimbursement. Premera will no longer pay separately for such equipment but will resume the prior policy of considering such equipment to be part of the services covered under standard office visit codes. PPE will no longer be reimbursed as of dates of service on Nov. 1, 2020 and after.
  •  Providers should correctly code for PPE using HCPCS codes (A-series of codes) for coverage of gowns and masks. Premera notes that the “A” codes typically billed for such miscellaneous supplies are:
    •  A4927 – Gloves, non-sterile
    •  A4928 – Surgical masks
    •  A4930 – Gloves, sterile

Practices should submit their standard charges or acquisition costs for each visit, and each contract will either have a set fee (not to exceed billed charges), or a default percentage. All other “miscellaneous codes” billed will potentially incur a “denial,” not for PPE, but for other reasons. Providers can access a copy of the policy on the OneHealthPort website.

Practices that were not aware of Premera’s policy can be reimbursed for those PPE expenses if those charges were not included in claims already submitted. They would need to rebill per the above guidance for dates of service prior to Nov. 1, 2020. For any further clarifications, please contact your Premera Provider service.