Coronavirus Testing in the Outpatient Setting
Defines outpatient coverage criteria and limitations for coronavirus (SARS-CoV-2, SARS, MERS, endemic HCoVs) testing modalities (nucleic acid, antigen, host antibody, panel testing, sequencing/genotyping) for medical decision making; excludes work/school/mandated testing and addresses reimbursement guidance for outpatient claims.
Added NAAT as acceptable for MIS-A, MIS-C, and PASC to meet coverage criteria.
Updated CC5 to allow antigen testing for symptomatic individuals once every 48 hours.
Removed CC7 and CC9 due to redundancy with Pathogen Panel Testing policy (G2149).
Removed CPT/HCPCS codes (0224U, 87631, 87632, 87633, 0115U, 0202U, 0223U, 0225U, C9803) in prior revisions.
Reworded CC11 to state host antibody serology testing does NOT meet coverage criteria for situations not otherwise described.
Updated background, guidelines, and extensive evidence-based references (06/01/2025).