COVID-19 Testing clinical policy updates

Having trouble viewing this email? View it as a Web page.

Health Care Authority (HCA) logo

Apple Health (Medicaid) Provider Alert

Attention providers:

The Health Care Authority (HCA) revised the Apple Health (Medicaid) clinical policy and billing for COVID-19 Frequently Asked Questions and removed the COVID-19 testing clinical policy from this FAQ document and moved it to a separate document titled Apple Health (Medicaid) COVID-19 testing clinical policy.

The Medicaid program pays for Coronavirus disease 2019 (COVID-19) molecular, antigen and antibody testing for medically necessary diagnostic services ordered by a qualified provider.

What changed?

The newly created COVID-19 testing clinical policy includes a table listing the covered diagnostic lab tests and antibody tests. HCA made the following changes to the list of covered codes:

  • Added the following covered COVID-19 diagnostic lab tests: CPT® codes 87636, 87637, 87811, and 87428.
  • Added the following covered COVID-19 related antibody tests: CPT® codes 86408 and 86409.

COVID-19 Fee Schedule

HCA reduced the rate for CPT® code 87426 (antigen test - severe acute respiratory syndrome coronavirus) after conducting a market analysis. The revised rate is $8.39.

See HCA’s Provider billing guides and fee schedules, under COVID-19, for HCA’s revised Emergency COVID-19 Fee Schedule.


CPT copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.