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    v1.0.31
    OpenPayerPolicy UpdatesLaboratory/PathologyArkansas BCBS COVID-19 Testing Coverage | OpenPaye…
    Ask Trek AI about this page
    CurrentArkansas Blue Cross and Blue ShieldPolicy N/A

    Are all tests for COVID-19 covered?

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    This document explains when COVID-19 diagnostic tests are covered without member copayment, coinsurance, or deductible. It applies to members and providers seeking coverage for FDA-approved or pending-approval COVID-19 tests used for individualized diagnosis.

    Policy Summary
    PayerArkansas Blue Cross and Blue Shield
    PolicyAre all tests for COVID-19 covered?
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionEnsure the COVID-19 diagnostic test is FDA-approved or pending approval, ordered by a provider, medically appropriate, and intended for diagnostic purposes.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    4Requirements for coverage without member cost-sharing
    2Specified covered COVID-19 test types
    3Covered situations
    3Situations not covered without cost-sharing

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Diagnostic Testing Coverage Criteria

    Diagnostic COVID-19 testing

    Covered without a copay, coinsurance, or deductible when all of the following are met.

    Coverage without member cost-sharing

    • FDA status: The test has been approved by the federal Food & Drug Administration or there is a pending request for such approval.
    • Ordering: The test has been ordered by a provider.
    • Medical appropriateness: The test is medically appropriate for the individual.
    • Purpose: The test is for diagnostic purposes.

    Testing for general workplace health and safety, including employee return-to-work programs, public health surveillance, or other purposes not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition, does not qualify for coverage without member cost-sharing.

    Testing is not covered without member cost-sharing when a member has no COVID-19 symptoms or high-risk exposure and is tested merely out of curiosity about whether they have COVID-19 or had it in the past.

    Testing of symptom-free employees without high-risk exposures solely to determine whether they may return to the workplace is not covered without member cost-sharing.

    Covered Testing Situations

    Members with symptoms of COVID-19

    Covered without member cost-sharing when all general diagnostic testing requirements are met.

    • FDA status: The test has been approved by the federal Food & Drug Administration or there is a pending request for such approval.
    • Ordering: The test has been ordered by a provider.
    • Medical appropriateness: The test is medically appropriate for the individual.
    • Purpose: The test is for diagnostic purposes.

    Members with a high-risk exposure

    Covered without member cost-sharing when all general diagnostic testing requirements are met.

    High-risk exposure

    • FDA status: The test has been approved by the federal Food & Drug Administration or there is a pending request for such approval.
    • Ordering: The test has been ordered by a provider.
    • Medical appropriateness: The test is medically appropriate for the individual.
    • Purpose: The test is for diagnostic purposes.

    Checking whether the member is free of the virus after a positive test

    Covered without member cost-sharing when all general diagnostic testing requirements are met.

    Testing after a positive test

    • FDA status: The test has been approved by the federal Food & Drug Administration or there is a pending request for such approval.
    • Ordering: The test has been ordered by a provider.
    • Medical appropriateness: The test is medically appropriate for the individual.
    • Purpose: The test is for diagnostic purposes.

    Covered Diagnostic Test Codes

    Covered CPT CodesCPTCovered
    87635Amplified nucleic acid (e.g. RT-PCR) tests
    87426Antigen tests

    Provider and Coverage Requirements

    Denial Risk

    Confirm qualifying diagnostic criteria

    Coverage without member cost-sharing is not required when the test is not FDA-approved or pending FDA approval, is not medically appropriate for the individual, has not been ordered by a provider, or is not for diagnostic purposes. General workplace screening, public health surveillance, curiosity testing, and symptom-free employee return-to-work testing without high-risk exposure do not qualify.

    Policy Background

    The policy distinguishes individualized diagnostic testing from screening performed for workplace health and safety, public health surveillance, return-to-work programs, or other non-diagnostic purposes. Coverage without member cost-sharing applies when testing is intended to diagnose or treat COVID-19 or another health condition in an individual and the applicable coverage requirements are met; general workplace or surveillance screening does not qualify.

    Key Definitions

    Diagnostic purposes
    DefinitionTesting primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition.
    Qualifying purposeThe test must be used for diagnostic purposes to qualify for coverage without member cost-sharing.
    Not includedGeneral workplace health and safety screening, public health surveillance, and other testing not primarily intended for individualized diagnosis or treatment do not qualify.
    High-risk exposure
    DefinitionExposure meeting the applicable Centers for Disease Control and Prevention guidance for high-risk exposure.
    Covered scenarioMembers with a high-risk exposure as defined by CDC guidance may receive coverage without member cost-sharing when the general diagnostic testing requirements are met.
    Related requirementThe test must also be ordered by a provider and be medically appropriate for the individual.

    Test Ordering

    Note

    Order the test through a provider

    Ensure the COVID-19 diagnostic test is ordered by a provider.

    Testing Not Covered Without Cost-Sharing Protection

    The following testing situations are not covered without member cost-sharing: asymptomatic members without a high-risk exposure who are testing out of curiosity about current or past infection; symptom-free employees without high-risk exposures tested solely to return to the workplace; and testing for general workplace health and safety, public health surveillance, or other non-diagnostic purposes.

    Policy Summary
    PayerArkansas Blue Cross and Blue Shield
    PolicyAre all tests for COVID-19 covered?
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionEnsure the COVID-19 diagnostic test is FDA-approved or pending approval, ordered by a provider, medically appropriate, and intended for diagnostic purposes.
    SourceLink
    On This Page
    Diagnostic Testing Coverage CriteriaCovered Testing SituationsCovered Diagnostic Test CodesProvider and Coverage RequirementsPolicy BackgroundKey DefinitionsTest OrderingTesting Not Covered Without Cost-Sharing Protection