UPDATE – Johnson & Johnson COVID-19 vaccine news
As of April 13, 2021, the FDA and CDC are recommending a pause in the use of the Johnson & Johnson (Janssen) COVID-19 vaccine due to a very rare and severe blood clot in some individuals who received it. Safety is a top priority for the CDC, and the use of this vaccine is on hold until these cases and analysis can be further reviewed and assessed later this week. Review this update for more information and how claims will be handled during this time.
COVID-19 billing and temporary provision updates
Last update: April 19, 2021, 5:19 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 by a physician or appropriately licensed health care professional for purposes of the diagnosis or treatment of an individual member.*
UnitedHealthcare will cover testing for employment, education, public health or surveillance 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. 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 members enrolled in Medicare Advantage, Medicaid and Individual and Group Market health plans. Please do not collect upfront payment from the member. Benefits will be otherwise adjudicated in accordance with the member’s health plan. We will reimburse COVID-19 testing in accordance with applicable law, including the CARES Act and UnitedHealthcare’s 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.
We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.
We’ll be making daily updates to this site. Be sure to check back often for the latest information.
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.