COVID-19 testing clinical policy updates, Eff. 05/12/2023

Washington State Health Care Authority sent this bulletin at 05/24/2023 10:01 AM PDT

May 24, 2023

Apple Health (Medicaid) Provider Alert

Attention providers:

What changed?

Retroactive to claims with dates of service on and after May 12, 2023, HCA updated the COVID-19 testing clinical policy billing guide with the following:

In the PCR tests section, removed “Professional claims” and “Facility claims” columns. At the end of the section, added a note box stating, “Due to the end of the public health emergency, effective for dates of service on and after May 12, 2023, modifier CR is no longer required.”
In the Antigen tests section, removed “Professional claims” and “Facility claims” columns. At the end of the section, added a note box stating, “Due to the end of the public health emergency, effective for dates of service on and after May 12, 2023, modifier CR is no longer required.”
In the Antibody Testing for SARS-CoV-2 section under Limitations, removed “Professional claims” and “Facility claims” columns. At the end of the section, added a note box stating, “Due to the end of the public health emergency, effective for dates of service on and after May 12, 2023, modifier CR is no longer required.”
In the Antibody Testing for SARS-CoV-2 section under Pharmacists/pharmacies, deleted all information in the section except for the note box. Added the statement, “Effective for dates of service on and after May 12, 2023, HCA no longer reimburses for COVID-19 PCR tests and antigen tests when prescribed or administered by a pharmacist.”
In the Over the Counter (OTC) Testing section, removed all non-pharmacy point-of-sale (POS)-related OTC test information; changed the test limitation from 12 tests, per client, per month to 2 tests, per client, per month; and added that pharmacies must bill claims for OTC COVID-19 tests through the POS system.

For more information, see the What has changed table in the updated guide on HCA’s Provider billing guides and fee schedules webpage under COVID-19, Policies and billing guidance.

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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COVID-19 testing clinical policy updates, Eff. 05/12/2023

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination