For dates of service or admittance on or after February 4, 2020, providers will be eligible to seek reimbursement for COVID-19 testing and testing-related visits for uninsured individuals, treatment for uninsured individuals with a COVID-19 primary diagnosis, and COVID-19 vaccination administration fees. All claims will be subject to the same timely filing requirements required by Medicare and available funding.
Reimbursement under this program will be made for qualifying testing for COVID-19, for treatment services with a primary COVID-19 diagnosis, and for qualifying COVID-19 vaccine administration fees, as determined by HRSA (subject to adjustment as may be necessary), which include the following:
Specimen collection, diagnostic and antibody testing.
Testing-related visits including in the following settings: office, urgent care or emergency room or telehealth.
Treatment, including office visit (including telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), acute inpatient rehab, home health, DME (e.g., oxygen, ventilator), emergency ambulance transportation, non-emergent patient transfers via ambulance, and FDA-licensed, authorized, or approved treatments as they become available for COVID-19 treatment.
Note: Monoclonal antibody therapy (M0239, bamlanivimab) when administered alone will only be covered for dates of service Nov. 10, 2020, through April 16, 2021, per the FDA Emergency Use Authorization.
Administration fees related to FDA-licensed or authorized vaccines.
View billing codes for more info.
Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded:
Any treatment without a COVID-19 primary diagnosis, except for pregnancy when the COVID-19 code may be listed as secondary.
Outpatient prescription drugs.
All claims submitted must be complete and final. Corrected claims, late charges, voided claim transactions and appeals will not be accepted. Interim bills may be accepted for outpatient hospital claims with dates of service that cross over a calendar year.