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.
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