New Payment Policy: COVID-19 Testing

  • April 1, 2022

    In this new COVID-19 testing policy, Premera will reimburse testing only in the scenarios noted below:

    • Diagnostic testing:  Molecular and antigen tests for the detection of SARS-Co-V-2 will be covered and reimbursed when the test has received EUA approval by the FDA. An attending provider determines the test is medically necessary for the diagnosis of COVID-19 and the test is being used to diagnose and/or treat an individual suspected of having the coronavirus infection.
    • Surveillance testing:  When testing is performed solely for data collection, analysis, public health screening, return to work or school, occupational, or travel, it will not be covered or reimbursed. This kind of testing is required to be billed with one of the diagnosis codes listed in the policy.
    • Over-the-counter (OTC) COVID-19 test kits:  Effective with purchase dates of January 15, 2022, and after, self-administered tests and self-read at home tests that have no involvement of a health care provider will be reimbursed for each individual enrollee up to 8 individual tests per a 30-day period.  Such tests will either be submitted by the member per the claim submission instructions out on the Premera member portal (Coronavirus & Your Healthcare | Premera Blue Cross) or purchased at an in-network pharmacy or from an in-network provider.

    To review the full details of the new COVID-19 testing policy, sign in to your OneHealthPort account to access the new policy.

  •    Email this article