COVID-19 testing clinical policy update, Eff 10/1/2021

Washington State Health Care Authority sent this bulletin at 09/28/2021 02:44 PM PDT

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Apple Health (Medicaid) Provider Alert

Attention providers:

What changed?

Effective for claims with dates of service on and after October 1, 2021, the Health Care Authority (HCA) updated the COVID-19 testing clinical policy as follows:

Added the following limits for PCR and antigen tests:

4 PCR tests per month, per client; and
4 antigen tests per month, per client

For additional tests, providers must submit a limitation extension request
to HCA.

Added over-the-counter (OTC) COVID testing and billing information for pharmacies.

Pharmacies may bill for OTC tests prescribed by a provider with prescriptive authority, using a standing order, or when a pharmacist has a collaborative practice agreement that allows for COVID testing.
To bill for the OTC COVID tests, pharmacies must follow the NCPDP standard and use the national drug code (NDC) or universal product code (UPC) found on the package.
Pharmacies may not bill for test administration of an OTC COVID test. These tests should be used by the patient in the home setting.

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 update, Eff 10/1/2021

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination