February 3, 2022
On January 15, 2022, the federal mandate requiring health plans to cover member-purchased over-the-counter (OTC) COVID-19 tests went into effect. These are for diagnostic purposes only and use a specific claim
form. Members may purchase up to 8 tests per covered member per 30-day period. The tests are covered as individual tests and not as a package (i.e., most tests come as a package of 2). Read our FAQ for information on which tests are covered and get a link to the claim form.
COVID-19 diagnostic tests handled in a provider’s office should continue to be billed as a medical service and shouldn’t use the member-submitted form. For information on coding diagnostic tests, read our COVID-19 FAQ.
The federal government also released information on their test kits, which can be ordered now through covidtests.gov. There is a limit of 4 tests per household. Our COVID-19 FAQ has the latest information on date extensions, new codes, and other requirements.