blue cross blue shield federal covid test reimbursement
I received a check from Blue Shield. Effective for claims with discharge dates or dates of service on or after April 1, 2020, for all commercial products, we have updated our APR-DRG grouper with the ICD-10 diagnosis codes below. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. Serologic testing for the presence of SARS-CoV-2 IgM/IgG antibodies is covered for FDA and Emergency Use Authorization tests (as described above) when ordered by a health care provider who is making an individualized clinical assessment of the patient in accordance with current standards of medical practice, including the Centers for Disease Control (CDC) and Massachusetts Department of Public Health (DPH) guidelines. Outside of an emergency situation, you should seek care from in-network providers to save money. When you provide telehealth or telephonic services, bill on a facility claim using a professional revenue code with the telehealth services outlined in our COVID-19 Temporary payment policy. If you havent yet paid the provider, the check goes to the provider. Patient symptoms are expected to improve with cognitive rehabilitation. If I need to get tested for travel, is that covered? This makes it easier to treat and improve the outcome. cRequired for employment purposes. Blue Cross Blue Shield of Massachusetts has a similar reimbursement model, with an initial submission form available on its website. Some restrictions apply. The DOI asked insurers to continue covering these medications for rheumatologic or dermatologic conditions under their current policies. Reimbursement Process Link or Description: Medicare members can get up to eight OTC COVID-19 home tests each calendar month. What your Blue Shield plan covers Your health is our priority. Yes. 14Self-funded plans may not cover all of an out-of-network providers charges for services related to COVID-19 testing. For in-network outpatient professional behavioral health providers, you should submit a claim to Florida Blue using one of the regular codes included in your fee schedule. For more details, please see fepblue.org. During the Public Health Emergency (PHE), over-the-counter (OTC) COVID-19 FDA-authorized test kits are covered for eligible members and will be reimbursed with no member cost share based on the federal guidance. Schedule an appointment in your area. Use one of the following telehealth modifiers on all lines billed: GT, 95, G0, or GQ. Federal Employee Program (FEP) members Please check yourEvidence of Coverageor plan policy documents to find out what is covered when traveling internationally. People may also access free or affordably priced testing in the community. OTC at-home tests that are reimbursed by other entities like a flexible spending account (FSA), health savings account (HSA) or health reimbursement account (HRA) or through reselling are not covered. We are in the process of determining what the end of the Massachusetts public health emergency means to our business and our provider partners. The screenshot below shows the correct way to enter modifiers. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Antibody testing The member will be responsible for any unrelated fees charged by an out-of-network provider. You will only be reimbursed for the maximum allowable tests per member per month for your plan. Some members may also contact you for a prescription for up to a 90-day supply from the Express Scripts Pharmacy'(mail order). Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. California Physicians' Service DBA Blue Shield of California 1999-2023. Under the rule, insurance providers are . https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage, Reimbursement Process Link or Description: Call us at 877-352-5830 with questions about COVID-19 testing sites, navigating health care plans or for help connecting to local community resources for finding food, utility and rent assistance, and many other types of relief programs. Contact the company for the latest information. Beginning January 15, 2022, and until the end of the Public Health Emergency, Independence will cover up to eight FDA approved OTC COVID-19 tests per calendar month as directed by the Biden administrations program. FEP will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance if diagnosed with COVID-19. Reimbursement Process Link or Description: COVID-19 Testing Coverage Website: We highly recommend you review the host countrys COVID-19 requirements before you travel. Please choose, Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. We expect providers to code for COVID-19 testing and treatment using guidelines provided by the CDC. COVID-19 testing thats ordered by a healthcare provider who is licensed to order these tests. Medi-Cal members: Do not submit any claims to Blue Shield Promise. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. If you use the online form, you must file a separate digital claim for each member and for each receipt. What options do I have for at-home test kits at no cost? Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. You are now leaving the blueshieldca.com website, In-depth information about choices that affect you. 6Neither diagnostic nor screening testing is covered through pharmacy benefits. Check with your insurer for the most up-to-date information for your specific plan. For example, if four people are covered by your health plan, you can get up to 32 tests per month. Simply fill out our Public Health Emergency Credentialing Application (PHE App). The program is . Contact the company for the latest information. Questions about medical or prescription coverage? Some plans may also have access to Teladoc or NurseHelp 24/7 as other options for virtual care. However, they will not be able to order a COVID-19 test for you. Legal | Privacy Policy, OptumRx Over-the-Counter Test Reimbursement Form. For providers not in the Teladoc network, the applicable cost share will apply (unless COVID-19 related). COVID-19 booster recommendations In Massachusetts, call, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x10, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x10, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x10, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x10, Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring, Injection, casirivimab and imdevimab, 2400 mg, Injection, bamlanivimab and etesevimab, 2100 mg, Blue Cross Blue Shield of Massachusetts is temporarily allowing reimbursement for this code for drive-through testing specimen collection*, Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source*, CDC 2019 novel coronavirus (2019-ncov) real-time 1-800-316-BLUE (2583), Dental Network Management Staying up to date with COVID-19 vaccinations protects against the worst outcomes of COVID-19. Medi_22_194_LS_IA_092722 When reporting the telehealth modifier, if applicable, please place the telehealth modifier after the license modifier. Anthem is waiving cost shares for COVID-19 treatment. Talk to board-certified doctors24/7 by phone or video. Update: BCBSTX Approach to OTC COVID-19 Testing Coverage - COVID 19 Producers | Blue Cross and Blue Shield of Texas This page may have documents that can't be read by screen reader software. 10Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. Keep your purchase receipt(s) to submit for reimbursement. PCR or antigen testing to detect SARS-CoV-2 is not covered in the following scenarios: Antibody testing As of January 15, 2022, private health insurers are required to cover up to eight at-home COVID-19 diagnostic tests per month for each person covered by a health plan.Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered. For members using the National Preferred Formulary (managed by Express Scripts, Inc.), there are new quantity limits for these medications. If you have a Medicare Advantage Plan, you must have a healthcare provider order for your OTC at-home test purchases to be reimbursed by Blue Shield. Members who filled a prescription for rheumatological and dermatological use within the previous 180 days are excluded from the quantity limit. COVID-19 Vaccine Information | CareFirst BlueCross BlueShield At-Home Rapid Tests Are Now Covered Over-the-counter COVID-19 tests are now covered for qualifying members. See which plans cover screening tests for travel. For PPO/Insurance Company inquiries, please call 517-364-8456 or (toll-free) 800-203-9519. Medicare Advantage members Out-of-pocket costs for COVID-19 testing: in-network vs. out-of-network. https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: Note: These changes do not apply to our Medicare Advantage members. Similarly, FEP will waive any copays or deductibles for diagnostic tests or treatment that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. FEP will also eliminate any cost share for prescriptions for up to a 14-day supply. https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html, https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html, : https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html, https://www.bcbsm.com/content/dam/public/shared/documents/coronavirus/covid-testing-member-reimbursement-form.pdf, https://covidtest.optumrx.com/covid-test-reimbursement, In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA, COVID-19 Over-the-Counter (OTC) Test Kit Claim Form [PDF], https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kits, https://www.humana.com/coronavirus/coverage-faqs, https://www.mclarenhealthplan.org/mhp/are-you-a-member, https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049, https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, https://www.hioscar.com/at-home-covid-test-reimbursement, https://www.hioscar.com/search/facilities?specialty_id=3336C0003X&network_id=017&year=2022&zip_code=49444&searchUrl=https%3A%2F%2F, https://www.paramounthealthcare.com/news/reimbursement-for-over-the-counter-covid-19-at-home-test-kits, https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kits, https://www.phpmichigan.com/?id=175&sid=1, https://www.priorityhealth.com/covid-19/vaccine, https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverage, Life Insurance and Annuity Search Service (LIAS), Health Insurer FIS 322 Submission Application, Financial Education (Banking, Credit Union and Credit Information), Establishing a program to have tests mailed directly to you upon request, or. Please be aware that this statement is. As of Jan. 15, 2022, and through the end of the public health emergency, all individuals with pharmacy coverage through Blue Cross Blue Shield of Michigan and Blue Care Network have more ways to get at-home COVID-19 rapid diagnostic tests at no cost. Serologic testing for the presence of antibodies for known or suspected current or prior COVID-19 infection is covered for FDA-approved tests when ordered by any healthcare professional authorized under state law. 1996-Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Illinois (BCBSIL) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). Y0118_22_338A1_C 09272022 You can also purchase an FDA-authorized over the counter COVID-19 test kit at other stores or online retailers. All Rights Reserved. https://www.priorityhealth.com/covid-19/vaccine, COVID-19 Testing Coverage Website: How can I get a free OTC COVID-19 test? Member cost still applies for an in-person, outpatient visits and for inpatient and residential services. Claims must include proof of purchase (e.g. The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. 108950 0122R be the regular place of service as if you saw the patient in-person. How can I tell if the OTC at-home test is authorized by the Food and Drug Administration (FDA)? We have added these codes to our COVID-19 Temporary payment policy. Bill for administration of first dose of CPT 91300 (Pfizer-BioNtech COVID-19 vaccine), Bill for administration of second dose of CPT 91300 (Pfizer-BioNTech COVID-19 vaccine), Bill for administration of first dose of CPT 91301 (Moderna-COVID-19 vaccine), Bill for administration of second dose of CPT 91301 (Moderna-COVID-19 vaccine), Bill for administration of CPT 91303 (Janssen COVID-19 Vaccine). Providing Support During the COVID-19 Pandemic Communities Leading through a public health crisis All 35 Blue Cross and Blue Shield companies are fighting against COVID-19, investing more than $12.8 billion in the nation's recovery. COVID-19 Testing Coverage Website: Test kit cost $ This information is provided for informational purposes only. Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. There are new codes for these boosters. "We are requiring insurers and group health. Network of Preferred Providers: The COVID-19 Temporary payment policy applies. If you purchase an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim to Cigna for reimbursement. 4These can be group plans from employers, associations, trusts, etc. BinaxNOW COVID-19 Antigen Self-Test (Abbott), BD Veritor At-Home COVID-19 Test (Becton Dickinson), CareStart COVID-19 Antigen Home Test (Access Bio), Celltrion DiaTrust COVID-19 Ag Home-Test (Celltrion), CLINITEST Rapid COVID-19 Antigen Self-Test (Siemens), Flowflex COVID-19 Antigen Home Test (ACON), iHealth COVID-19 Antigen Rapid Test (iHealth Labs), QuickVue At-Home OTC COVID-19 Test (Quidel), SCoV-2 Ag Detect Rapid Self-Test (InBios), See a complete list of authorized tests on the FDA's web page. Starting Saturday, private health plans are required to cover the over-the-counter tests at up to $12 per test. In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. Bill as if you are performing an in-person service, using the revenue and HCPCS/CPT code combinations that you would normally bill on a facility claim. Your plan will provide this coverage through reimbursement to you. What should I do with it? The use of reverse transcription-polymerase chain reaction (RT-PCR) or antigen testing to detect the presence of SARS-CoV-2 for a diagnosis of COVID-19 infection is covered for FDA-approved tests when ordered by any healthcare professional authorized under state law. www.hioscar.com%2Fsearch%2F%3FnetworkId%3D017%26year%3D2022, Reimbursement Process Link or Description: Learn more about the COVID-19 vaccine booster. prescription receipt and UPC Code from the packaging) and other information reasonably requested by McLaren to validate payment. Effective March 16, 2020, Blue Cross and Blue Shield of Alabama is expanding telehealth coverage. If your provider has not submitted a claim to Blue Shield for you,visit our How to file a claim pageto learn more. Leading the way in health insurance since 1929. We will continue to monitor and assess potential impacts to our business and our provider partners as the state considers any further actions on measures established during the state of emergency. Chloroquine and hydroxychloroquine (Plaquenil), On June 5, 2020, the FDA revoked the Emergency Use Authorization (EUA) for hydroxychloroquine and chloroquine for the treatment of COVID-19 because the benefits of using them outweigh the known and potential risks for authorized use. For more details please visit fepblue.org. 2023 Blue Cross Blue Shield Association. These tests can be ordered by visiting covidtests.gov. Diagnosis Codes: B97.29 Z03.818 Z20.822 For more information, see Medical Policy 660: Cognitive Rehabilitation, Telehealth (telephone calls and video visits). You can get up to eight at-home COVID-19 tests per month for every person covered on your health plan. *UB-04 billers do not need to submit a place of service code. We have plans to help keep you covered. You will be reimbursed for over-the-counter COVID-19 diagnostic tests purchased on or after January 15, 2022. continue to monitor and will be responsive to state and federal guidance. Ralphs Clinic Testing Services for Viral or Rapid Antigen Tests, contact Medi-Cal Rx to locate an in-network pharmacy, See details for how to submit a claim for reimbursement for covered testing, Find out what your coverage is for OTC at-home tests based on your plan, Medi-Cal members: Do not submit any claims to Blue Shield Promise, Yes for OTC at-home tests purchased on or after 1/15/22, Medicare Prescription Drug Plan (pharmacy benefit only), No, coverage for OTC at-home tests is covered by Original Medicare, Yes, for purchases between 1/1/22 4/3/22, None for covered tests during the public health emergency. Log in and to go Office Resources>Billing & Reimbursement>Fee schedules. On the test kit package, look for a message that states the test has been authorized for emergency use by the FDA. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Many Blue Cross Blue Shield of Rhode Island plans include $0 coverage for COVID-19 test kits without a prescription. UB-04 billers do not need to enter a place of service when billing for services provided by phone. If you did not receive a refund from your provider, please contact their office. We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. Then, complete and submit the online form. If you are interested in a rewarding position helping Michiganders apply today! Blue Cross Blue Shield of Massachusetts will reimburse telehealth covered claims that we receive through the BlueCard program. The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. Hear from community leaders and other experts. For example, a physician, a nurse practitioner, or a physician assistant. Or, contact our Clinical Pharmacy Operations area. Blue Cross also removes all referral and authorization requirements for outpatient care if a member is being evaluated or treated for suspected or confirmed COVID-19. National vaccine finder. For Marketplace inquiries, please call 517-364-8567 or (toll-free) 866-539-3342. Billing for partial hospitalization and intensive outpatient using telehealth.