COVID-19 Testing clinical policy updates

Washington State Health Care Authority sent this bulletin at 11/20/2020 03:47 PM PST

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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.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

COVID-19 Testing clinical policy updates

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination