This article was revised on December 29, 2020, to update the coverage effective dates. To learn about billing and coding for
COVID-19 testing, please read this article. ​

AmeriHealth is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all AmeriHealth members and providers to visit our dedicated AmeriHealth New Jersey or AmeriHealth Pennsylvania COVID-19 webpages regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Member coverage for COVID-19 testing and treatment

Testing

AmeriHealth New Jersey will cover COVID-19 testing as follows:

• Diagnostic tests: Covered without member cost-sharing* (i.e., copayment, deductible, and coinsurance) and without an order or prescription by a licensed or qualified health care professional, when performed at any site, including a physician's office, urgent care center, hospital or hospital emergency room, pharmacy or during a home health visit or drive-through testing center visit.
• Antibody tests: Covered without member cost-sharing* when performed at a physician's office, urgent care center, hospital or hospital emergency room, pharmacy or during a home health visit or drive-through testing center visit, when ordered or authorized by a licensed or qualified health care professional. 

Coverage for AmeriHealth New Jersey members for both in and out-of-network testing and diagnosis of COVID-19 is effective March 6, 2020, until 90 days after the end of both the state of emergency and the public health emergency declared by the State of New Jersey in response to COVID-19.

AmeriHealth Pennsylvania will cover COVID-19 diagnostic tests and antibody tests with no member cost-sharing when directed by the member's health care provider. Testing coverage for AmeriHealth Pennsylvania members is effective March 6, 2020,​ through the end of the public health emergency.

*The waiver of cost-sharing for both in and out-of-network testing and diagnosis of COVID-19 will continue until 90 days after the end of both the state of emergency and public health emergency declared by the state of New Jersey. For High Deductible Health Plans, in-network cost-sharing waivers will remain in effect through March 31, 2021, unless prohibited by law.

Specimen collection administered by health care professionals and processed at an approved lab

• ​Diagnostic RT-PCR and antigen tests and antibody tests: AmeriHealth will cover (i) certain COVID-19 tests (diagnostic RT-PCR and antigen tests, and antibody tests), including COVID-19 tests that have been approved, cleared, or authorized by the U.S. Food & Drug Administration (FDA) or for which the developer has requested, or intends to request, Emergency Use Authorization (EUA) for the COVID-19 pandemic; and (ii) the administration of such tests, when ordered or authorized by a licensed health care provider or in accordance with the coverage noted above, and performed at an approved health care setting. (This includes drive-through testing).​ 
  

  Such testing will only be covered if medically appropriate as determined by the member's health care provider in accordance with accepted standards of current medical practice. We recommend that providers confirm with AmeriHealth if the lab processing the test is an authorized and/or contracted lab and if they have the ability to perform such testing.

  Lab specimens for members enrolled in HMO and HMO-POS p​​roducts may need to be sent to a different approved laboratory, which is not the member's designated capitated laboratory site, when the designated capitated laboratory site does not have the ability to perform the COVID-19 test.

  Referral and out of capitation authorization requirements have been waived for COVID-19 Laboratory Testing HCPCS codes 0202U, 0223U, 0224U, 0225U, 0226U, U0001, U0002, U0003, U0004, G2023, G2024, and CPT^® codes 86143, 86328, 86408, 86409, 86769, 87635, and 87246.

  Laboratory Corporation of America^® Holdings (LabCorp), the exclusive national outpatient laboratory provider for AmeriHealth, is equipped to process diagnostic (RT-PCR) and antibody (IgG) COVID-19 specimen testing for our members. 

  Please visit our AmeriHealth New Jersey or AmeriHealth Pennsylvania websites for current listing of available patient testing sites. 

  You can review the Diagnostic RT-PCR coverage statement in the medical policy.​​
  

• Differential diagnosis: AmeriHealth will cover testing of other clinically relevant respiratory pathogens, for the differential diagnosis of COVID-19. These tests include testing of the following pathogens through any clinically established method:
• adenovirus
• influenza
• human metapneumovirus (HmPV)
• parainfluenza
• respiratory syncytial virus (RSV)
• rhinovirus (common cold)

Referral and out of capitation authorization requirements have also been waived for COVID-19 differential diagnosis laboratory testing procedure codes when performed in conjunction with COVID-19 laboratory testing.

Specimen collection by an authorized worker from a home health agency

AmeriHealth is waiving the requirement that members must be homebound to receive COVID-19 specimen collection at home.

Members are no longer required to be homebound (as defined in the medical policy) to receive a nurse visit from a home health agency or trained laboratory technician for the purpose of laboratory specimen collection for COVID-19 testing in their home, when the visit for specimen collection:

• is medically necessary/appropriate for the individual's condition; and,
• has been ordered by a licensed or otherwise qualified health care provider. 

The specimen must be delivered to an authorized laboratory to perform the test and the results sent to the prescribing/ordering professional provider.

AmeriHealth participating providers, in accordance with their provider agreement, are required to refer specimens to participating laboratories. Precertification for home care services is required.​

Specimen collection by members

• Home test kits: Home test kits that are collected and processed at home will be covered if medically appropriate when ordered or authorized by a health care professional licensed and/or qualified to do so under state law. Members should not submit claims for reimbursement unless such test was medically appropriate.  
  
• ​At-home self-sample collection: AmeriHealth will cover diagnostic testing of samples self-collected by members at home when medically appropriate and the testing will be processed at an approved laboratory following FDA EUA guidance, and self-collection materials (including kits) have received specific FDA EUA approval.
  
  ​​For example, the FDA re-issued EUA for LabCorp COVID-19 RT-PCR Test to permit testing of samples self-collected by members at home using LabCorp's Pixel by LabCorp COVID-19 Test home collection kit.

Routine testing

• In advance of procedures: Reimbursement for routine COVID-19 laboratory testing, for asymptomatic and/or nonexposed individuals, (e.g., preadmission testing; screening prior to procedures as part of an institutional protocol) is reimbursed as part of the procedural or surgical payment and is not eligible for separate reimbursement.
• Testing of nursing home residents and patients: Per CMS and CDC guidance, facilities cannot seek separate reimbursement for tests of nursing home residents and patients. These tests are reimbursed as part of the per diem payment to the facility.

Public health surveillance and screening

• ​AmeriHealth does not cover COVID-19 testing when the primary purpose of the test is for public health surveillance and/or screening. For information on screening and public health surveillance, please refer to the policy article Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)), on our Medical and Claim Payment Policy Portal in the News & Announceme​nts section.​ ​

Treatment

Effective March 30, 2020, through March 31, 2021, AmeriHealth will cover the treatment of COVID-19 as follows:

• AmeriHealth will waive cost-sharing for in-network, inpatient, acute care treatment of members diagnosed with COVID-19, whether for medical or behavioral health.
• AmeriHealth will waive cost-sharing for emergency department visits associated with admissions for in-network, in-patient, acute care treatment of COVID-19 whether for medical or behavioral health.

For services not related to COVID-19, we will continue to apply the appropriate member cost-sharing.

This includes members enrolled in our fully insured commercial plans and the individual and family plans available through the Affordable Care Act.

Note: AmeriHealth Pennsylvania self-funded customers can opt out of waiving cost-sharing for the treatment of COVID-19. 

In addition, cost-sharing is waived for AmeriHealth New Jersey members for any telemedicine services from an in-network provider. Cost-sharing is waived for AmeriHealth Pennsylvania members for primary care physician telemedicine visits. To learn more about our telemedicine positions, please read the article for AmeriHealth New Jersey or AmeriHealth Pennsylvania.

AmeriHealth will reimburse health care providers for the testing and treatment of COVID-19 as outlined above at their contracted rates including the member cost-share amount.

Prescribing

In response to COVID-19 and potential shortages of medications that may be effective against the virus, prescribers should include the patient's diagnosis on the prescription. If written for a COVID-19 diagnosis, the diagnosis needs to be confirmed by a positive test result and documented on the prescription.

AmeriHealth previously lifted prescription refill restrictions, such as the “refill too soon" limit, for members with AmeriHealth pharmacy benefits. Members were also encouraged to speak with their providers regarding using their 90-day mail order benefit to see if that option makes sense for them.

These measures are important and help members access the prescription drugs they need to manage chronic conditions and maintain good health. However, out of an abundance of caution and to help prevent drug shortages, we are modifying the prescription refill restrictions that were previously lifted. Now, members must have used at least two-thirds of their current medication supply before a refill would be possible.

Note: Self-funded groups can opt-out of the new modifications.

Please review the policy News Article, Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)), for more detailed information. You can view this article for AmeriHealth New Jersey or AmeriHealth Pennsylvania members on our Medical and Claim Payment Policy Portal in the News & Announcements section.​

Learn more

For more information about the AmeriHealth position on COVID-19, please review the following resources:

• COVID-19 webpages for AmeriHealth New Jersey or AmeriHealth Pennsylvania 
• Policy information

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