During the federal public health emergency, Blue Shield will continue to waive out-of-pocket costs for copays, coinsurance, and deductibles for: COVID-19 screenings or evaluations done: Virtually using telehealth, In a doctor's office, At an urgent care center, or In a hospital (including emergency room). Will it be covered? If you havent yet paid the provider, the check goes to the provider. Coronavirus (COVID-19) Resource Center | Anthem Several drugs are under investigation as potential treatments for COVID-19 that have shown early benefit in clinical trials. You are now leaving the blueshieldca.com website, In-depth information about choices that affect you. A list of reports produced by our Department. 3If you receive your health insurance through your employer, association, trust, etc., please contact your employer, plan sponsor, or benefits administrator to see whether you have a fully-insured or a flex-funded group plan. If you would like to find a new mental healthcare provider in your network, learnhow to find one. An attending health care provider may order a test. For example, if four people are covered by your health plan, you can get up to 32 tests per month. You must use one of the following telehealth modifiers (GT, 95, G0, and GQ) with the applicable place of service code. Below are the codes for providers and laboratories to test patients for COVID-19. Standard office visit copay may apply. Submit a claim online, or download the COVID-19 Over-the-Counter (OTC) Test Kit Claim Form [PDF] and submit via mail or fax using the instructions on the form. A diagnostic test is used to determine if a person has COVID-19. 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 DIFS is not responsible for any costs incurred in reliance on this information. For assisted reproductive technology services listed in ourmedical policythat require prior authorization: Durable medical equipment COVID-19 Information for our clinical partners We are here to support you as you care for your patientsour members. This policy applies to Blue Cross Blue Shield of Massachusettsmembers*in the following plans: Note: Employers who are self-insured may choose not to offer waived cost share for their employees. Or, contact our Clinical Pharmacy Operations area. For information about your insurer's network of preferred providers and reimbursement process, see the information below. Viral testing If a test reader is required, reimbursement is limited to $12. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. COVID-19 Testing Coverage Website: Members are responsible for any fees or tests that are not covered by their plan. At-Home COVID Test Reimbursement: From Blue Shield to Kaiser - KQED If you purchased an at-home test previously, you may be able to get paid back. Some restrictions apply. Phone Number: In that case, you may be responsible for paying the difference. The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. OTC at-home tests must have been purchased on or after January 1, 2022. Use one of the following telehealth modifiers on all lines billed: GT, 95, G0, or GQ. Reimbursement Process Link or Description: Insurance Coverage for Over-the-Counter COVID-19 Tests - Michigan If you plan to provide a previously approved service under an authorization that expired on December 31, 2020 to a patient in 2021, please call our Clinical Intake Department at the appropriate number and we will create a new authorization or update the existing one. Find out when Blue Shield covers COVID-19 tests and whether or not you'll have a copay. https://www.phpmichigan.com/?id=175&sid=1. Reimbursement for tests purchased before January 15, 2022: Establishing a network of preferred providers that will enable you to go directly to a designated pharmacy or retailer to obtain free tests. SECTION 2 - PATIENT INFORMATION Reason for the test cI was exposed to someone with COVID-19. How can I get a free OTC COVID-19 test? Click Reimbursement Form. Plus learn how to safely resume healthcare visits. UB-04 billers do not need to enter a place of service when billing for services provided by phone. 5Self-funded group plans are not required to cover these costs. You can find a list of community-based testing sites here. Those payments will now go directly to the provider. Were contacting them to suggest that they take advantage of our early refill policy during this public health emergency, so they can have a supply of their medication. Commercial members: Managed care (HMO and POS), PPO, and Indemnity. UPDATE: COVID-19 over the counter testing reimbursement - IBX Newsroom For Medicare Advantage plans, you must submit claims for COVID-19 vaccine and the administration of the vaccine to the CMS Medicare Administrative Contractor (MAC) for payment. For Federal Employee Program (FEP) members, member cost is removed for inpatient acute care hospitals, inpatient rehab facilities, long-term acute care hospitals, and skilled nursing facilities for services related to COVID-19. When the claim processes and you receive your Provider Detail Advisory, youll know whether the member has a cost to collect. Please enter the NDC or UPC number from the cash register receipt. I received a check from Blue Shield. They can advise you on how to return the money back into your account. Please choosein-network locationsfor testing to avoid paying any extra fees. Schedule your COVID-19 vaccine booster today. How you will bill for services by phone depends upon your specialty. In accordance with the Centers for Disease Control (CDC) and the MA Department of Public Health guidelines, covered scenarios include (but are not limited to): * Individual exposures added together over a 24-hour period (e.g., three 5-minute exposures for a total of 15 minutes). Many Blue Cross Blue Shield of Rhode Island plans include $0 coverage for COVID-19 test kits without a prescription. Seewhichtestsarecoveredforyourplan. https://www.paramounthealthcare.com/news/reimbursement-for-over-the-counter-covid-19-at-home-test-kits, Phone Number: The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. 13Other fees unrelated to the administration of the COVID-19 test may be charged for your visit. 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. Coronavirus (COVID-19) | Anthem Blue Cross They are basically the same. up to $12 per test under the safe harbor (for plans that provide access to the tests . All rights reserved. To bill for telehealth/video services during the state of emergency. This benefit is available to Blue Shield and Blue Shield Promise members in the following plans: You should bring your red, white, and blue Medicare card to get your free OTC COVID-19 tests. Health plans are offered by Blue Shield of California. You should follow existing claims reimbursement processes to obtain an at-home test reimbursement. These tests are available without out-of-pocket cost at locations specified by your insurance company. Blue Shield of California has neither reviewed nor endorsed this information. *These modifiers do not apply to Federal Employee Program members. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. The Blue Cross Blue Shield (BCBS) Association, a federation of 35 independent health insurance companies that collectively cover one in three Americans, has voiced concern with the COVID-19 test . New bivalent boosters from Moderna (ages 6 months and up) and Pfizer (ages 6 months and up) are now available. Please be aware that this statement isnota bill. Learn how to get free OTC at-home teststhrough the federal program. How to Submit Your At-Home COVID Test to Your Insurance - Health Why we made the change With a BCBSTX health plan, you have access to care for COVID-19 related health issues. PCR or antigen testing to detect SARS-CoV-2 is not covered in the following scenarios: Antibody testing FEP will also eliminate any cost share for prescriptions for up to a 14-day supply. COVID-19 test Note: Cost share waive for to COVID-19 treatment expires on 08/31/2021. Effective January 15, 2022 and thru the end of the Public Health Emergency (PHE), OTC tests that are approved under the FDA Emergency Use Authorization In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA will be covered at $0 cost to the customer, without a health care provider order or individualized clinical assessment. As of April 4, 2022, the Centers for Medicare & Medicaid Services (CMS) is covering up to eight free OTC COVID-19 at-home tests each calendar month at participating pharmacies and healthcare providers. To bill for telehealth, follow the same telehealth billing guidelines as you would for an in-person visit and include the following modifiers with the applicable place of service as outlined in the COVID-19 Temporary payment policy: Bill fortelephonicservices using the additional billing guidelines and applicable place of service codes in our COVID-19 Temporary payment policy. 9PCR tests (polymerase chain reaction) tests which are generally sent to a lab, but may also include rapid tests such asNucleic Acid Amplification Tests(NAAT). Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Cognitive impairments resulted from COVID-19 that was either clinically diagnosed or diagnosed through PCR/Antigen testing. Screening tests for domestic travel are covered for most plans. Since the drug is supplied free, we will not reimburse separately for the drug regardless of modifier. Members will have the option of online submission through the secure member website or sending a paper submission. 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. How to get at-home test costs covered: Submit a reimbursement claim form by mail. Schedule an appointment in your area. We removed the member cost for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. The instructions and form are provided on the COVID-19 home test kit page: https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html. *The CDC has created an interim set of ICD-10 CM official coding guidelines, effective February 20, 2020. Licensees of the Blue Cross and Blue Shield Association. Health plans are offered by Blue Shield of California. The Massachusetts Division of Insurance (DOI) issued aMarch 26, 2020 Bulletinaddressing this topic. FEP will determine coverage for the vaccine once it becomes available. For example, if you purchase a package with two tests inside, that counts as two separate tests. 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). DIFS Prohibition Orders for Consumer Finance and Credit Union. Find out which COVID-19 tests are available to members and where to get tested. National vaccine finder. UnitedHealthcare (UHC) Log in to your member account on our website. Medicare members can get up to eight OTC COVID-19 home tests each calendar month. The program is . It is provided as a general resource to providers regarding the overpayment recovery process that may be available for commercial claims. Questions about medical or prescription coverage? Coronavirus (COVID-19) Update Center - Blue Cross and Blue Shield of In response, Blue Cross will expand telehealth to ease access to appropriate medical services for our customers. PDF COVID-19 Update as of Oct. 21, 2021 - Florida Blue Members who already have coverage for problem-focused exams (D0140) will have no cost share (deductible, copayment, or co-insurance).*. You can get up to eight at-home COVID-19 tests per month for every person covered on your health plan. Over-the-Counter Tests | CareFirst BlueCross BlueShield Testing sites: Not all testing sites are the same. Network of Preferred Providers: WASHINGTON The Blue Cross and Blue Shield Federal Employee Program (FEP) announced today that it will waive cost-sharing for coronavirus diagnostic testing, waive prior authorization requirements for treatment and take other steps to enhance access to care for those needing treatment for COVID-19 to ensure its members can swiftly access the right care in the right setting during the outbreak. WASHINGTON - The Blue Cross and Blue Shield Federal Employee Program (FEP) announced today that it will waive cost-sharing for coronavirus diagnostic testing, waive prior authorization requirements for treatment and take other steps to enhance access to care for those needing treatment for COVID-19 to ensure its members can swiftly access the 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, Asymptomatic and without known COVID-19 contact, Contact with and (suspected) exposure to other viral communicable diseases, Symptomatic or has been exposed to COVID-19, Encounter for observation for suspected exposure to other biological agents ruled out, Encounter for screening for COVID-19 (Effective January 1, 2021), Contact with and (suspected) exposure to COVID-19 (Effective January 1, 2021), Other coronavirus as the cause of diseases classified elsewhere, SARS-associated coronavirus as the cause of diseases classified elsewhere, 2019-nCOV acute respiratory disease (Effective April 1, 2020), Pneumonia due to COVID-19 (Effective January 1, 2021), Multisystem inflammatory syndrome (Effective January 1, 2021), Other specified systemic involvement of connective tissue (Effective January 1, 2021), Diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital) to hospital, Residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home to hospital, Hospital to diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital), Hospital to residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home, Hospital to hospital (includes ASCs approved to provide hospital level of care), Hospital to alternative site for skilled nursing facility (SNF), Freestanding end-stage renal disease (ESRD) facility to skilled nursing facility, Skilled nursing facility to freestanding end-stage renal disease (ESRD) facility, Physician office to community mental health center, federally qualified health center, rural health center, urgent care facility, non-provider-based ambulatory surgical center or freestanding emergency center, or location furnishing dialysis services that is not affiliated with an end-stage renal facility, Physician office to residential, domiciliary, custodial facility (other than skilled nursing) if the facility is the beneficiarys home. We have plans to help keep you covered. This helps make sure you dont have to pay more out-of-pocket. . That form will be replaced on Jan. 23 once the insurer develops . How can I continue seeing my mental health care provider? That being said, I called my insurance provider, Blue Cross Blue Shield of Texas (BCBSTX) to ask if I could submit a claim for my test from last week. 10Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. These amounts not paid by the plan may be the responsibility of the member. Claims submission and reimbursement for all COVID-19 testing. You will have to pay for your tests up front and should save your receipts and test boxes for submission to your insurance company for reimbursement. www.bcbsm.com/coronavirus. For more resources, visit myturn.org and the CDC websites. Contact the provider to find out how they want to be reimbursed. I have a Medicare plan. Send us an email at DIFSInfo@michigan.gov, Department of Insurance and Financial Services, Additional Financial and Insurance Services Forms, https://dev.michigan.local/som/json?sc_device=json, Insurance Coverage for Over-the-Counter COVID-19 Tests, Go to Licensing - Consumer Finance and Mortgage, Go to Additional Financial and Insurance Services Forms, Go to DIFS Biographies and Public Officials. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kits, COVID-19 Testing Coverage Website: News & updates Not all plans have access to these services. Log in to find out your costs and if you have access. Claims for over-the-counter COVID-19 tests submitted for reimbursement will be reimbursed up to $12 per test. Most diagnostic and screening tests are covered for the majority of Blue Shield members. Information Regarding Coronavirus (COVID-19) | Highmark BCBSWNY Additional doses are given to boost the immune response from the vaccine. Network of Preferred Providers: California Physicians' Service DBA Blue Shield of California 1999-2023. Covered tests must be approved by the FDA or haveEmergency Use Authorization, or the developer must have requested, or intends to request Emergency Use Authorization approval. Reimbursement for tests purchased before January 15, 2022: Claims for laboratory services including COVID-19 testing, On or after July 1, 2021, the ordering clinician NPI will be a required field on your claim to indicate that the lab test is medically necessary. Assisted reproductive technology services Covered investigational drugs Claims must include proof of purchase (e.g. Members can register for Teladoc by visiting fepblue.org/coronavirus. 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. If a vaccine administration service is provided with an evaluation and management service that: This applies to professional and facility claims. https://www.humana.com/coronavirus/coverage-faqs. What to do if you think you have COVID-19. You can offer telehealth as long as you are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. In addition, ground ambulance transport to and from the locations listed below is covered to help our healthcare delivery system optimize inpatient capacity. You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). Unrelated fees:These are other fees that may be charged for your visit, but are unrelated to the test itself. We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. In a hospital (including emergency room). What's Covered - COVID-19 | Blue Cross and Blue Shield of Texas - BCBSTX We will reimburse medically necessary telehealth and visits by phone at the same rate as an in-person visit, for all providers, including behavioral health providers. Your plan may require you to sign an attestation that the test was purchased: Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. However, they will not be able to order a COVID-19 test for you. See details on theState Medi-Cal websitefor how to submit a claim. Under the rule, insurance providers are . you purchased the test. continue to monitor and will be responsive to state and federal guidance. Once a COVID-19 vaccine has EUA or approval from the FDA, Blue Cross will accept this vaccine CPT code and administrative codes. 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. Kaiser's California Member Services hotline is (800) 464-4000. 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.