COVID-19 testing FAQ

Are you getting questions from your patients about COVID-19 testing?

The following information can help you answer questions from your Regence patients:

Question

Diagnostic (Antigen or Molecular)

Antibody (Serology)

How is the test done?

Nasal swab, throat swab or test of saliva

Finger stick or blood draw

What does the test tell me?

The antigen and molecular diagnostic tests can show if you currently have an active or acute infection of COVID-19, which is caused by the SARS CoV2 virus.

The antibody (or serology) test, when accurate, can tell if you’ve had a prior infection of a SARS CoV2 like virus.

What doesn’t the test tell me?

The antigen or molecular diagnostic tests do not indicate if you’ve had COVID-19 or another coronavirus infection in the past.

The antibody test does not indicate if you have an active COVID-19 infection, and it does not tell you if you are immune from a future COVID-19 infection.

How reliable are the tests?

Antigen or molecular diagnostic tests have different reliability rates.

Many different labs have tests available to diagnose COVID-19 or active coronavirus infection. There are several factors that can affect the test’s accuracy including but not limited to swabbing or sampling techniques, keeping the sample at the correct temperature and the lab’s performance analyzing the sample. As a result, no test is 100% accurate all of the time. Please refer to the U.S. Food and Drug Administration website for more information.

Other resources: U.S. Food and Drug Administration: Coronavirus Testing Basics and the Centers for Disease Control and Prevention Overview of Testing for SARS-CoV-2

The current accuracy of antibody tests is improving; however, there remains no evidence of immunity to future COVID-19 infection. Visit the FDA website for the most up-to-date accuracy information on antibody testing.

Many different labs have tests available to diagnose COVID-19 or active coronavirus infection. There are several factors that can affect the test’s accuracy including but not limited to swabbing or sampling techniques, keeping the sample at the correct temperature and the lab’s performance analyzing the sample. As a result, no test is 100% accurate all of the time. Please refer to the U.S. Food and Drug Administration website for more information.

Other resources: U.S. Food and Drug Administration: Coronavirus Testing Basics and the Centers for Disease Control and Prevention Overview of Testing for SARS-CoV-2

What’s covered by law?

FDA-emergency-use-authorized or CLIA-lab diagnostic testing, including the associated provider visit, when ordered by your attending provider as part of appropriate medical care.

FDA-emergency-use-authorized or CLIA-lab antibody testing when ordered by your attending provider as part of appropriate medical care.

I am an Individual or group member, what does my insurance cover?

Antigen or molecular diagnostic tests and services provided during the visit that resulted in the order for the test when ordered by a provider or a pharmacist as part of appropriate medical care.

Beginning on January 15, 2022, following the new federal guidelines:

We will cover the cost of eight over-the-counter (OTC) rapid tests per member (age two and older) each month without cost sharing for diagnostic purposes without a provider’s order. More than eight tests will require a prescription.

Some kits may include multiple tests in the kit. For example, if the kit comes with two tests in the box, we will cover four boxes per member, per month.

OTC tests will be covered through the federal public health emergency.

View answers to frequently asked questions on our member website.

Our COVID-19 Testing (Administrative #137) reimbursement policy will be updated as soon as we have more details.

Antibody tests when ordered by a provider or a pharmacist as part of appropriate medical care.

I am a Medicare Advantage member, what does my insurance cover?

Antigen or molecular diagnostic tests and services provided during the visit that resulted in the order for the test when ordered by a licensed health care professional and part of appropriate medical care.

Effective April 4, 2022, CMS announced eight OTC tests per member per month are covered at no cost for beneficiaries with Medicare Part B, including those enrolled in a Medicare Advantage plan, who receive the tests from participating pharmacies or health care providers. The member should present their Medicare card (red, white and blue card) to the pharmacy and providers. Claims must be submitted directly to Medicare for these services to be covered. Medicare will reimburse participating pharmacies and providers. Note: If we receive a member reimbursement claim form from a member with a provider order, we will cover the eight OTC tests per member per month.

There is not a limit on the number of antibody tests a member can receive when ordered by a licensed health care professional and part of appropriate medical care.

What isn’t covered by insurance?

Antigen or molecular diagnostic tests for:

  • Surveillance
  • Community tracking
  • Epidemiologic purposes
  • Research purposes
  • Employment purposes (e.g., staffing decisions)
  • Screening (e.g., travel, sports, school, camp, recreational, social requirement, events)
  • Determining the need for personal protective equipment

Note: Per correct coding guidelines, be sure to include the appropriate diagnosis code to indicate the reason for testing (e.g., testing done as a requirement to enter an event could include Z02.89 Encounter for other administrative examination).

Antibody testing for:

  • Surveillance
  • Community tracking
  • Epidemiologic purposes
  • Research purposes
  • Employment purposes (e.g., staffing decisions)
  • Screening (e.g., travel, sports, school, camp, recreational, social requirement, events)
  • Determining the need for personal protective equipment

Note: Per correct coding guidelines, be sure to include the appropriate diagnosis code to indicate the reason for testing (e.g., testing done as a requirement to enter an event could include Z02.89 Encounter for other administrative examination).

The Equal Employment Opportunity Commission has issued guidance that forbids employers from requiring workers to take a COVID-19 antibody test before entering the workplace, citing CDC recommendations that these tests should not be used for return to work requirements and American’s with Disabilities Act requirements.

Neutralizing antibody tests are used to identify potential donors of convalescent plasma. We do not cover these tests because they are not used for diagnosis or treatment of the person being tested.

View our COVID-19 testing policies

View information for Blue Cross and Blue Shield Federal Employee Program® (BCBS FEP®) members.

View all COVID-19 updates and resources.