CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

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

Defines BCBSRI reimbursement determination and pricing for COVID-19 diagnostic testing, monoclonal antibody treatments, and vaccines and vaccine administration for in-network and out-of-network providers during the Public Health Emergency.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

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

Policy CodePolicy N/A

Change TypeNo material change

Effective Date02|01|2021

Next Review DateN/A

Key ActionPrior authorization is not applicable for the services covered under this policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

100% of Medicarereimbursement rate for listed COVID-19 services

Jan 31, 2020+timeframe referenced for covered services

in-network & out-of-networkprovider applicability

02|01|2021policy effective date as published

Covered Services and Pricing

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Covered services and pricing

BCBSRI will reimburse the following COVID-19 related services at 100% of Medicare reimbursement rates during the policy timeframe:

ALL of the following

ONE OF
- COVID-19 Laboratory In Vitro Diagnostic Testing
- Monoclonal Antibody Treatments
- Vaccines and Administration of Vaccines
Pricing: 100% of Medicare reimbursement rates (as documented in CMS fee schedules, which may change from time to time)
Applicability: Applies to BCBSRI in-network/participating providers and out-of-network/nonparticipating providers with BCBSRI

ALL of the following

Timeframe: Beginning of the Public Health Emergency (e.g., January 31, 2020) and while this policy is in effect

ALL of the following

Coding reference: See related policies for specific COVID-19 test, vaccine, and monoclonal antibody treatment codes and fee schedules
See related policies for specific code sets and fee schedules

Coding and Reimbursement Rate

Coding referencemixed

See related policies for specific COVID-19 test, vaccine, and monoclonal antibody treatment codes and fee schedules

Reimbursement rate — 100% of Medicare reimbursement rates

Reimbursement rateBCBSRI will reimburse listed COVID-19 services at 100% of Medicare reimbursement rates (per CMS fee schedules).

Applies to plansMedicare Advantage Plans and Commercial Products.

Services includedApplies to COVID-19 Laboratory In Vitro Diagnostic Testing, Monoclonal Antibody Treatments, and Vaccines and Administration of Vaccines.

Fee schedule sourceRates as documented in CMS fee schedules, which may change over time.

Provider Billing and Authorization Requirements

Prior Authorization

Prior Authorization — Not applicable

Prior authorization: Not applicable. No prior authorization is required for services covered under this policy.

Applies to all services governed by this policy.
If a member’s benefit plan or separate certificate requires prior authorization for specific services, follow that plan’s requirements.

Covered COVID-19 Services Definitions

Covered COVID-19 services

Covered services (definition)COVID-19 Laboratory In Vitro Diagnostic Testing; Monoclonal Antibody Treatments; Vaccines and Administration of Vaccines, as defined in BCBSRI related policies.

Effective timeframeFrom 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 policy referencesSee BCBSRI related policies: COVID-19 Monoclonal Antibody Treatment; COVID-19 Vaccinations; TEMPORARY COVID-19 Diagnostic Testing.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

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

Policy CodePolicy N/A

Change TypeNo material change

Effective Date02|01|2021

Next Review DateN/A

Key ActionPrior authorization is not applicable for the services covered under this policy.

SourceLink

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