error
May 5, 2021 at 3:00 PM CT

UPDATE – Getting questions about vaccines? These resources can help

Now more than ever, patients may be asking questions about the safety and effectiveness of the COVID-19 vaccines. These resources can help answer those questions and give you information to share: 1) The Building COVID-19 Vaccine Confidence self-paced learning course has tips and scenarios that will help you respond during conversations with members. 2) Our Vaccine Confidence resources page has direct links to vaccine information from the AMA, CDC and more. And 3) The What to know about COVID-19 vaccines resource site can help members learn more and consider their options.

COVID-19 billing and temporary provision updates

The COVID-19 Billing Guide and Summary of COVID-19 Temporary Program Provisions are handy references to current program and billing information.

COVID-19 Testing, Treatment, Coding & Reimbursement

Last update: June 18, 2021, 4:00 p.m. CT

Testing, coding and reimbursement protocols and guidelines are established based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other health agencies. We’re closely monitoring COVID-19-related updates from these partners and updating this site as quickly as possible when new information is available. Care providers should work with local and state health departments to coordinate testing. 

Members should work with their provider to order a test. Additional member guidance on testing can be found here.

COVID-19 Testing Guidance

UnitedHealthcare will cover medically appropriate COVID-19 testing during the national public health emergency period (currently scheduled to end July 19, 2021), at no cost share, when ordered or reviewed by a physician or appropriately licensed health care professional* to either:

1) diagnose if the virus is present due to symptoms or potential exposure, or 2) help in the treatment of the virus for a person

UnitedHealthcare will cover testing for employment, education, travel, public health, surveillance or social purposes when required by applicable law. Benefits will be adjudicated in accordance with a member’s benefit plan. Health benefit plans generally do not cover testing for surveillance or public health purposes. 

COVID-19 tests purchased or processed over the counter without a prescription or health care professional’s involvement, such as those bought at a pharmacy or online, are not covered by the member’s benefits plan. Members will be responsible for the cost and may use their health savings account (HSA), flexible spending account (FSA) or health reimbursement account (HRA). If you provide a prescription for an over-the-counter COVID-19 test as part of clinical care, you may submit a claim for reimbursement with both the prescription and detailed receipt to UnitedHealthcare.

We continue to monitor regulatory developments during emergency periods.

Tests must be FDA authorized to be covered without cost sharing (copayment, coinsurance or deductible). FDA-authorized tests include tests approved for patient use through pre-market approval or emergency use pathways, and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval.

This coverage applies to in-network and out-of-of-network tests for Medicare Advantage, Exchange, Individual and Employer-sponsored health plans. For individuals enrolled in UnitedHealthcare Community Plans, state variations and regulations may apply during this time. Please do not collect upfront payment from the member.

If members receive medical services or advice for other conditions at the same time as receiving a COVID test, then cost sharing will be adjudicated in accordance with the member’s health plan and they will be responsible for any copay, coinsurance, deductible or other out-of-network costs.   

We will reimburse COVID-19 testing in accordance with applicable law, including the CARES Act and UnitedHealthcare reimbursement requirements. State variations and regulations may apply during this time. 

UnitedHealthcare is requesting all physicians and health care professionals who perform and bill for COVID-19 antibody tests to register the test(s) that will be used for our members.

*Licensure requirements vary by state. In some states, a pharmacist or other health care professional, such as a nurse practitioner, may have the appropriate licensure to order a test. Please refer to state-specific licensure requirements for appropriate guidance.

Date Reference Guide: Keep track of which temporary measures are expiring and which are being extended with our Summary of COVID-19 Temporary Program Provisions.

Continued Support: We are committed to business continuity and being there to assist you. All self-service capabilities are available, our call center is staffed and claims are being processed so you have the support you need.

Testing and Cost Share

Treatment and Cost Share

Claim Coding, Submissions and Reimbursement

Resources

Care providers can connect to the latest Centers for Disease Control and Prevention (CDC) guidance for health professionals, as well as travel advisories from the U.S. State Department.

Find COVID-19 vaccine availability for your state or territory.


Disclaimer:

The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency.  Additional benefits or limitations may apply in some states and under some plans during this time.

We will adjudicate benefits in accordance with the member’s health plan.

Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.