Proper Billing and Dispensing for COVID-19 At-Home Tests and Home Collection Kits   

Proper Billing and Dispensing for COVID-19 At-Home Tests and Home Collection Kits   

Standing Order: On December 10, 2021, MaineCare authorized a Standing Order for licensed pharmacists to create a prescription for Over the Counter (OTC), Direct to Consumer (DTC), and prescription COVID-19 at-home test collection kits for MaineCare members. The standing order is for MaineCare members only. See the Standing Order for more detail.   

Billing Guidance:  Providers must bill these tests and collection kits through our Maine Point of Purchase System (MEPOPS).  MaineCare will cover the tests with no member co-payment required. MaineCare cannot reimburse members for the tests after the sale, so providers must process claims through MEPOPS. Please use NPI number 1306045521 from the Standing Order as the prescriber NPI on the claim.   

Test Kit Limits:  MaineCare allows up to eight tests per month per member. For serial tests, bill as a QTY of two; non-serial tests, bill as a QTY of one.     

Products:  The products listed in the table below are currently preferred on the MaineCare Preferred Drug List (PDL). We may add new products as they become available. For coverage questions, please call the Change Healthcare Pharmacy Help Desk at 1-888-420-9711.