RetiredBlue Cross Blue Shield - Rhode IslandPolicy N/A

COVID-19 Diagnostic Testing, Vaccine and Antibody Treatment Administration Reimbursement

Defines BCBSRI reimbursement determinations for COVID-19 laboratory testing, monoclonal antibody treatment administration, and vaccines/administration for in-network and out-of-network providers during the COVID Public Health Emergency timeframe; applies to all BCBSRI participating and nonparticipating providers.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyCOVID-19 Diagnostic Testing, Vaccine and Antibody Treatment Administration Reimbursement

Policy CodePolicy N/A

Change TypeRetired / terminated effective May 12, 2023

Effective DateJan 2, 2021

Next Review DateN/A

Key ActionPrior authorization: Not applicable

SourceLink

POLICY UPDATE CHANGES

Policy will no longer be in effect beginning with dates of service on or after May 12, 2023, representing the end of the COVID Public Health Emergency (PHE).

100%of Medicare rates for listed COVID-19 services

May 12, 2023policy end date

In-network & out-of-networkprovider applicability

3covered service types

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Coverage Criteria for COVID-19 Services

inv-01: COVID-19 Laboratory Testing

BCBSRI reimbursement approach for Medicare Advantage and Commercial products:

COVID-19 Laboratory In Vitro Diagnostic Testing reimbursed at 100% of Medicare reimbursement rates (CMS or MAC fee schedule); if no CMS/MAC rate exists, reimbursed at BCBSRI standard fee schedule.

inv-02: Monoclonal Antibody Treatment Administration

Monoclonal Antibody Treatment Administration reimbursed at 100% of Medicare reimbursement rates (CMS or MAC fee schedule); if no CMS/MAC rate exists, reimbursed at BCBSRI standard fee schedule. BCBSRI will make reasonable efforts to reimburse out-of-network/non-participating providers directly but may pay the member per the subscriber agreement in some instances.

inv-03: Vaccines and Vaccine Administration

Vaccines and Administration of Vaccines reimbursed at 100% of Medicare reimbursement rates (CMS or MAC fee schedule); if no CMS/MAC rate exists, reimbursed at BCBSRI standard fee schedule.

Coding and Pricing

See related policies for specific codesmixed

No codes listed

Pricing basis

Pricing basisPriced at 100% of the Rhode Island CMS, National CMS or a Medicare Administrative Contractor (MAC) fee schedule when applicable; if no CMS/MAC rate exists, priced at BCBSRI's standard fee schedule

Rate updatesRates may be updated from time to time during the timeframe the policy is in effect

Applicability to codes without CMS/MAC ratesAny code/service without a CMS or MAC rate will be priced using BCBSRI's standard fee schedule

Scope of pricingApplies to services identified in this policy while the policy was in effect

Jurisdiction referenceRhode Island CMS rate used when applicable (100% of RI CMS)

Definitions

COVID-19 Laboratory In Vitro Diagnostic Testing

TermCOVID-19 Laboratory In Vitro Diagnostic Testing

ContextListed as a covered COVID-19 service in BCBSRI's policy overview beginning with the Public Health Emergency (e.g., January 31, 2020)

Provider applicabilityApplies to BCBSRI in-network/participating and out-of-network/nonparticipating providers

Related policiesDefined further in the policies listed in the Related Policies section

Monoclonal Antibody Treatment Administration

TermMonoclonal Antibody Treatment Administration

ContextIdentified as a covered COVID-19 service in the policy overview effective from the start of the Public Health Emergency

Provider applicabilityApplies to BCBSRI in-network/participating and out-of-network/nonparticipating providers

Related policiesSee BCBSRI's related policies for further details on treatments and coding

Vaccines and Administration of Vaccines

TermVaccines and Administration of Vaccines

ContextIncluded among COVID-19 services covered from the beginning of the Public Health Emergency (e.g., January 31, 2020)

Provider applicabilityApplies to BCBSRI in-network/participating and out-of-network/nonparticipating providers

Related policiesFurther defined in BCBSRI's related vaccination policies listed in the document

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyCOVID-19 Diagnostic Testing, Vaccine and Antibody Treatment Administration Reimbursement

Policy CodePolicy N/A

Change TypeRetired / terminated effective May 12, 2023

Effective DateJan 2, 2021

Next Review DateN/A

Key ActionPrior authorization: Not applicable

SourceLink

On This Page

OpenPayer

COVID-19 Diagnostic Testing, Vaccine and Antibody Treatment Administration Reimbursement

Coverage Criteria for COVID-19 Services

Coding and Pricing

Provider Actions and Billing Notes

Definitions