June 18, 2020
Premera’s Benefit Coverage Guideline is effective for serology tests for dates of service July 1, 2020 and forward. Premera will reimburse for serology tests that are for the purpose of supporting a COVID-19 diagnosis as part of the treatment or management of a patient’s medical condition.
Serology tests provided on an inpatient basis are presumed to be for diagnostic purposes. Tests performed on an outpatient basis require records confirming that the test is for the diagnosis of the disease or condition of a patient.
The Benefit Coverage Guideline follows CDC guidance on scenarios in which serology testing can be used for diagnostic purposes:
- Serologic testing can be offered as a method to support diagnosis of acute COVID-19 illness for persons who present late. For persons who present 9-14 days after illness onset, serologic testing can be offered in addition to recommended direct detection methods such as polymerase chain reaction.
- Serologic testing should be offered as a method to help establish a diagnosis when patients present with late complications of COVID-19 illness, such as multisystem inflammatory syndrome in children.
Serological tests will not be covered when provided as the sole basis of diagnosis for current infection with COVID-19.
We will be covering claims with dates of service June 30, 2020 or earlier. Refer to our COVID-19 FAQ for addition update and guidance.