COVID-19 Testing Updates: What’s Covered and What Isn’t Covered

November 3, 2021

Applies to: Group, Retail, Medicare Markets

During the public health emergency, we are covering COVID-19 tests that are FDA-authorized (FDA-approved, received FDA Emergency Use Authorization – “EUA,” or are in the process of receiving EUA) without cost-sharing. 

Coverage includes: 

• Any COVID-19 test that is FDA-authorized, such as rapid and antibody tests. 
• COVID-19 tests are covered at no cost-share to our members when an individual’s health care provider determines that it is medically appropriate to treat or diagnose COVID-19. 

Coverage does not include: 

• COVID-19 tests purchased over-the-counter; members are responsible for the cost. 
• COVID-19 surveillance testing, which is testing used for public health or social purposes such as employment (return to work), education, travel or entertainment, is not covered. 

What’s new: There is now a specific modifier for return-to-work testing claims to indicate a claim is for return-to-work programs. We’re educating providers on this modifier and will process claims according to how providers bill the claims.