Policy UpdatesMedicaidMay 1, 2024

Covid-19 testing in urgent care centers

Effective June 1, 2024, Covid-19 testing in an urgent care center will no longer be payable in addition to the contracted global rate. Testing for Covid -19 will be considered bundled into the urgent care center contracted global rate.

Please note, this is an update to the existing policy that took effect April 2023.

Impacted CPT®/HCPCS codes:

Code

Description

86328

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method

86408

Neutralizing antibody, severe acute respiratory syndrome coronavirus

86409

Neutralizing antibody, severe acute respiratory syndrome coronavirus

86413

Severe acute respiratory syndrome coronavirus 2

86769

Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

87426

Infectious agent antigen detection by immunoassay technique, (for example, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA]

87428

Infectious agent antigen detection by immunoassay technique, (for example, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (for example, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B SD: SARSCOV &

87635

Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

87636

Severe acute respiratory syndrome coronavirus 2

87637

Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus

87811

Infectious agent antigen detection by immunoassay with direct optical (for example, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Code

Description

0202U

Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

0223U

Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2), qualitative RT- PCR, nasopharyngeal swab, each pathogen reported as detected or not detected

0224U

Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed

0225U

Infectious disease (bacterial or viral respiratory tract infection) pathogen- specific DNA and RNA, 21 targets

0226U

Surrogate viral neutralization test (sVNT), severe acute respiratory

0240U

Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS- CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected

0241U

Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local provider relationship account management or call Provider Services at 833-707-0868.

Coverage provided by Wellpoint Maryland, Inc.

MDWP-CD-054028-24

PUBLICATIONS: May 2024 Provider Newsletter