There have been many changes in the coverage and payments for Covid 19 testing, treatments, and vaccines. Many of the states continue to have their emergency orders in place to provide these services for patients. Coverage for patients that have no insurance coverage has ended through HRSA as of April 5, 2022. Medicare, Medicaid, and Commercial payers continue to cover and pay for these services. Please reach out to us for further details and changes that have taken place over the past few months.
The FFCRA was enacted on March 18, 2020.4 Section 6001 of the FFCRA generally requires group health plans and health insurance issuers offering group or individual health insurance coverage to provide benefits for certain items and services related to testing and treatment for the detection of SARS-CoV-2, the virus that causes COVID-19.
The CARES Act was enacted on March 27, 2020.7 Section 3201 of the CARES Act amended section 6001 of the FFCRA to include a broader range of diagnostic items and services that plans and issuers must cover without any cost-sharing requirements, prior authorization, or other medical management requirements 8 Section 3202(a)
of the CARES Act generally requires plans and issuers providing coverage for these items and services to reimburse any provider of COVID-19 diagnostic testing or treatments an amount that equals the negotiated rate or, if the plan or issuer does not have a negotiated rate with the provider, the cash price for such service that is listed by the provider on a public website.
Covid-19 Diagnostic Testing
The SARS-CoV-2 RT-PCR test is a real-time test based on the reverse transcription-polymerase chain reaction (RT-PCR) for the qualitative detection of nucleic acid from SARS-CoV-2 in samples of the upper respiratory tract (oropharyngeal swabs) collected from individuals suspected by their healthcare provider to have COVID-19, belonging to a risk cohort, or having been in contact with a confirmed COVID-19 patient. RT-PCR test is the most reliable test and is used for the proper diagnosis and treatment of Covid-19.
CMS and other payors are still reimbursing for this testing for all of their members, and have not placed any limitations on the amount of testing at this time.
Covid-19 Vaccinations
Pursuant to Section 3713 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), once the FDA has authorized or approved a COVID-19 vaccine, the vaccine, and its administration, will be added to the list of preventive vaccines that are covered under Medicare Part B without coinsurance or deductible. The CARES Act provision amended Section 1861(s)(10)(A) of the Social Security Act (SSA).
The IFC includes provisions for implementing the requirement in section 3203 of the CARES Act that non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage provide coverage, without cost-sharing, for qualifying coronavirus preventive services, which includes COVID-19 immunizations.
Specifically, plans and issuers must cover COVID-19 immunizations that have in effect a recommendation of ACIP with respect to the individual involved, even if not listed for routine use on the Immunization Schedules of the CDC. This IFC also provides that during the public health emergency for COVID-19, plans and issuers must cover without cost-sharing qualifying coronavirus preventive services, regardless of whether an in-network or out-of-network provider delivers such services. The IFC also affirms that plans and issuers subject to section 2713 of the Public Health Service Act must cover without cost-sharing items and services that are integral to the furnishing of recommended preventive services, including the administration of COVID-19 immunizations.
Contact us today to discuss reimbursement availability on both the diagnostic testing and vaccinations. There are multiple ways that you can be paid for the services that you are providing during this continued pandemic.