COVID-19 (Coronavirus): Member coverage for testing

March 31, 2021

This article was revised on March 31, 2021, to move treatment information to a separate article, add new codes for lab testing, and add information regarding fees for administration of testing. To learn about treatment for COVID-19, please read this article. To learn about billing and coding for COVID-19 testing, please read this article.

Member coverage for COVID-19 testing  

Independence will cover and waive member cost-sharing (i.e., copayment, deductible, and coinsurance) for COVID-19 tests performed at physician offices, urgent care centers, emergency rooms, drive-through testing sites, pharmacies, and by home health agencies when ordered or authorized by a health care professional licensed and/or qualified to do so under state law as outlined below. Testing coverage for Commercial, Medicare Supplement, and Keystone CHIP member coverage is effective March 6, 2020, through the duration of the public health emergency. Testing coverage for Medicare Advantage members is through 2021.

Fees related to furnishing or administration of COVID-19 testing

There is no cost-sharing whether in network or out of network for fees related to the administration of the test rather than treatment for COVID-19.

Facility fees must be covered without cost-sharing whether in network or out of network to the extent the fees relate to the furnishing or administration of the test or evaluating for the need for the test.

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

  • Diagnostic RT-PCR and antigen tests and antibody tests: Independence 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 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 Independence 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 products 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, U0005, G2023, G2024, and CPT® codes 86143, 86328, 86408, 86409, 86769, 87635, 87246, and 87428.

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

Please visit our website for current listing of available patient testing sites.

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

  • Differential diagnosis: Independence 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

Independence is waiving the requirement that commercial and Medicare Advantage 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.Independence participating providers, in accordance with their provider agreement, are required to refer specimens to participating laboratories. Precertification for home care services is required.

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

Independence 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: Independence 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

Independence 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 News Articles linked below.

Working with LabCorp

LabCorp is equipped to perform diagnostic and antibody testing for COVID-19 for all Independence members, even those who are not capitated to LabCorp.

Testing

  • The LabCorp diagnostic RT-PCR and antibody (IgG) tests are available to all offices – hospitals, urgent care centers, and physician offices. Please follow the Centers for Disease Control and Prevention guidelines for ordering the tests. When ordering tests through LabCorp, use code 139900 for diagnostic tests and code 164055 for antibody tests.
  • LabCorp will not obtain COVID-19 specimens at their patient service centers (PSC). Any person trying to get a COVID-19 test at a LabCorp PSC will be referred to their physician.
  • LabCorp will collect antibody blood tests at their PSCs. Any person trying to get an antibody test must first place an order through a physician.

Note: The antibody test is only available for persons ages 18 or older.

Sending test specimens

The specimen should be sent in LabCorp's Universal Transport Media (UTM) tube from a Nasopharyngeal (NP) or Oropharyngeal (OP) swab collected and frozen in the office. If offices need swabs/UTM tubes, they can order from the normal supply process (i.e., email, call, beacon Link). Be sure to use a viral transport media swab for testing as a dry swab will not be accepted. Tests from other viral transport media may be acceptable; however, please contact LabCorp customer service at 1-800-631-5250 to confirm acceptable specimen types.

If your office does not have a routine pickup with LabCorp, please call 1-800-631-5250 for scheduling.

Supplies

               

Specimen collection reminders

  • LabCorp's COVID-19 test requires the collection of ONLY 1 swab, either an NP or OP but not both
  • LabCorp's test requires only one specimen type.
  • If a provider collects both an NP and OP swab, both swabs can be placed into a single UTM tube. The single UTM tube will not be rejected for COVID-19 testing.

Resources

Note: The Supply Order form can be faxed or emailed. Both swabs and UTMs can be ordered using this form. The UTM is on the form and the swab can be written in as the Nasopharyngeal or Oropharyngeal Swab.

A LabCorp account is needed to order the test. If you need to set up an account with LabCorp, visit NENewaccounts@labcorp.com or call 1-888-295-5915.

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

Learn more

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 on our Medical and Claim Payment Policy Portal in the News & Announcements section:

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