For any new codes where a CMS published rate does not exist, claims will be held until CMS publishes corresponding reimbursement information. Medicare wont cover over-the-counter COVID-19 tests if you only have Medicare Part A (Hospital Insurance) coverage, but you may be able to get free tests through other programs. CMS Releases Medicare Reimbursement Details for COVID-19 Tests Traditional Medicare beneficiaries who need post-acute care following a hospitalization would face copayments of $194.50 per day for extended days in a SNF (days 21-100). How to Submit a Claim - Blue Cross and Blue Shield's Federal Employee 0000007398 00000 n Reimbursement will be based on incurred date of service. Reimbursement for OTC at-home COVID-19 tests will vary, depending on your specific health plan and how your employer has chosen to administer the benefit. They are also required to conduct weekly testing of staff if they are located in states with a positivity rate of 5% or greater. COVID-19 | Independence Blue Cross - IBX Specimen collection, diagnostic and antibody testing. Under revised rules finalized on September 2, 2020, a beneficiary may receive Medicare coverage for one COVID-19 and related test without the order of a physician or other health practitioner, but then must receive a physician order for any further COVID-19 testing. For beneficiaries who may have recently exhausted their SNF benefits, the waiver from CMS authorizes renewed SNF coverage without first having to start a new benefit period. xref *Submitted claims will be paid subject to the availability of funds. Were here to help keep you informed about how to get over-the-counter (OTC) at-home COVID-19 tests. Any treatment without a COVID-19 primary diagnosis, except for pregnancy when the COVID-19 code may be listed as secondary. 0000031710 00000 n We are pleased that CMS listened to our concerns and found a path forward to cover over-the-counter tests for seniors.". 0000018235 00000 n Should I report my OTC at-home COVID-19 test result? Although the CARES Act specifically provided for Medicare coverage at no cost for COVID-19 vaccines licensed by the U.S. Food and Drug Administration (FDA), CMS has issued regulations requiring no-cost Medicare coverage of COVID-19 vaccines that are also authorized for use under an emergency use authorization (EUA) but not yet licensed by the FDA. Medicare also maintains several resources to help ensure beneficiaries receive the correct benefits while also avoiding the potential for fraud or scams. Please return to AARP.org to learn more about other benefits. Center for Disease Controls response to COVID-19, Coronavirus disease 2019 (COVID-19) diagnostic tests, Find Medicare.gov on facebook (link opens in a new tab), Follow Medicare.gov on Twitter (link opens in a new tab), Find Medicare.gov on YouTube (link opens in a new tab), A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services. Review the information here to learn about OTC at-home COVID-19 testing options that may be available for you. How do I get reimbursed for OTC at-home COVID-19 tests? During the COVID-19 PHE, get one lab-performed test without a health care professionals order, at no cost. Instructions for submitting form 1.

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