- View CMS established codes and reimbursement rates for monoclonal antibodies and their administration.
- View the Office of the Assistant Secretary for Preparedness and Response national map of locations that have received shipments of the monoclonal antibody therapeutics.
- Reimbursement policies:
- Commercial: COVID-19 Testing
- Medicare Advantage: COVID-19 Testing
- Policy includes information about coverage for repeat or subsequent COVID-19 testing ordered by a health care professional licensed and enrolled in the state that the services are rendered in and practicing within the scope of their license and part of appropriate medical care as determined by the attending health care professional. (One initial COVID-19 test is covered without an order by a health care professional)
COVID-19 Testing (Laboratory #74) medical policy
Access to COVID-19 testing is a critical component of public health and safety, enabling our members to navigate the pandemic. Beginning on January 15, 2022 for commercial members, following the new federal guidelines:
- Tests must be FDA- authorized or approved.
- Commercial members: Effective January 15, 2022, following the new federal guidelines:
- We will cover the cost of eight over-the-counter (OTC) rapid tests per member (age 2 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.)
- Medicare members: 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.
- OTC tests will be covered through the federal public health emergency.
- View answers to frequently asked questions on our member website.
- View our COVID-19 Testing (Administrative #137) commercial and Medicare Advantage reimbursement policies.
- We are not requiring pre-authorization for COVID-19 testing.
- We will cover the cost of the COVID-19 test and services provided during the visit that resulted in the order for the test with no cost share, if it is part of appropriate medical care and ordered by:
- Commercial members: The member’s attending provider or a pharmacist
- Medicare Advantage members: A licensed health care professional
- For Medicare Supplement members: Only the test is covered at no cost share.
- We will cover the cost of the COVID-19 test if it is provided prior to a procedure.
We will cover COVID-19 testing conducted at drive-up testing sites with no cost share, if a provider determines a test is necessary. Claims for tests conducted at drive-up sites should be submitted using POS 15.
For more information about coverage for COVID-19 testing, view the policies included below.
We recognize COVID-19 testing and services provided during the visit that resulted in the order for the test when billed with the following:
- Modifier CS must be added to each line item for COVID-19-testing related service per CMS Guidelines. (For telehealth claims, both modifier 95 and modifier CS must be included.)
- On August 27, 2020, CMS published guidelines to deny Medicare Advantage outpatient facility claims with services that CMS has indicated are not appropriate to bill with the CS modifier for dates of service beginning on March 18, 2020 through the end of the Public Health Emergency. The MLN Matters Number: SE20011 includes links to the list of the 208 procedure codes CMS has identified as appropriate to bill with CS modifier. We are applying these guidelines, effective October 16, 2020, to Medicare Advantage claims received on or after this date and to claims we are currently adjusting with dates of service beginning on March 18, 2020.
- For dates of service beginning on March 1, 2020, through December 31, 2020, bill:
- Z03.818 or Z20.828 in the primary position or
- Z03.818 or Z20.828 in a position other than the primary position with modifier CS on the appropriate line item. (For telehealth claims, both modifier 95 and modifier CS must be included.)
- For dates of service beginning on January 1, 2021, bill:
- Z20.822 in any position or
- Z20.822 with modifier CS on the appropriate line item.
For tests submitted by the provider or facility:
- The manufacturer of the test must be approved or authorized by the FDA or have been approved for FDA-Emergency Use Authorization- (EUA-) for the COVID-19 pandemic.
- The manufacturer’s name must be included on the electronic claim (837P or 837i) in the 2300 loop, NTE01 or NTE02 segment, either at claim level or line level. If the manufacturer’s name is not included on the claim, the provider will receive a letter requesting this information. The provider will receive two additional letters requesting the information. If no response is received in 90-days, the claim will be denied, following our normal process.
These codes are effective for claims with dates of service on or after March 1, 2020, and can be billed only by independent laboratories when specimen collection is for a patient who is homebound or nonhospital inpatient:
- HCPCS G2023: Specimen collection for severe acute respiratory syndrome coronavirus 2, any specimen source
HCPCS G2024: Specimen collection for severe acute respiratory syndrome coronavirus 2 from an individual in a skilled nursing facility (SNF) or by a laboratory on behalf of a home health agency (HHA), any specimen source
Note: These codes are not reimbursable when a patient collects their own specimen or when a messenger service is used to pick up the specimen.
In addition, HCPCS C9803 is applicable to specimen collection in only the hospital setting. This code is billable by professionals, independent labs or ambulatory surgical centers (ASCs) for claims with dates of service on or after March 1, 2020.
CPT 99211 should be used for lab specimen collection from a patient billed by a physician office for claims with dates of service on or after March 1, 2020. To indicate the specimen collection is specific to COVID-19 testing, providers should include the CS modifier and/or the diagnosis code, following the COVID-19 testing claim submission guidelines above.
LabCorp and Quest Diagnostics can test for COVID-19. Our provider networks include one or both of these labs. You can verify your patient's coverage using our provider search tool, Find a Doctor.
Note: Individuals seeking testing for COVID-19 should not visit a LabCorp or Quest Diagnostics location to request a test. Tests must be ordered by a physician or other authorized health care provider.
Providers can order the COVID-19 test the same way that other tests are ordered from LabCorp. If you are not already registered, create an account on LabCorp’s website.
More information about COVID-19, including answers to frequently asked questions, is available on LabCorp’s website.
Providers can order the test the same way that other tests are ordered from Quest Diagnostics. If you are not already registered, create an account on Quest Diagnostic’s website.
For more information, including a link to a Healthcare Provider Fact Sheet, visit Quest Diagnostic’s website.