Cigna SARS‑CoV‑2 Test Coverage Update

inv-01: Molecular or Antigen Testing (Initial)

Covered when ALL of the following are met:

Molecular/Antigen Medical Necessity: clinical concern for a symptomatic COVID-19 infection; ordered and administered by a licensed or authorized healthcare provider; test is FDA approved or cleared or has an Emergency Use Authorization (EUA); performed by a CLIA-certified high- or medium-complexity laboratory or CLIA-waived setting if directed by the test Instructions for Use

inv-02: Antibody (Serology) Testing

Covered when ALL of the following are met:

Antibody (Serology) Medical Necessity: ordered and administered by a licensed or authorized healthcare provider; test is FDA approved or cleared or has an Emergency Use Authorization (EUA); performed by a CLIA-certified high- or medium-complexity laboratory if so directed by the test Instructions for Use; results of a molecular or antigen test are non-diagnostic for COVID-19 and the serology will be used to aid in diagnosis of a condition related to COVID-19 (e.g., Multisystem Inflammatory Syndrome [MIS], post-acute sequelae)

inv-03: Appropriate Uses and Testing Pathways

Guidance and covered uses for SARS-CoV-2 testing:

Molecular NAAT (diagnostic) use: Recommended for symptomatic individuals suspected of COVID-19 and for certain asymptomatic individuals with known or suspected exposure; a single NAAT is suggested for symptomatic or asymptomatic individuals with an initial negative result; not routinely recommended for asymptomatic individuals without known exposure (including prior to hospitalization or procedures)

IDSA and FDA guidance referenced

Antigen testing: May be used in symptomatic individuals; a positive antigen result identifies infection but a negative antigen in a symptomatic person should be confirmed with an FDA-authorized NAAT; antigen tests are useful for point-of-care use and serial testing in high-risk congregate settings80% clinical sensitivity reported vs NAAT

CDC antigen testing algorithm recommended for confirmatory testing

Serology (antibody) testing: Not for diagnosis of acute infection; may aid in diagnosing MIS-C/MIS-A and to document prior exposure; should not be used to determine immunity post-vaccination; results must be interpreted in clinical context

No antibody test authorized to assess immunity

inv-04: Non-covered Indications

Not covered for individual diagnostic or administrative decisions under most plans:

Non-diagnostic administrative testing: Testing for return-to-work, return-to-school, participation in sports, pre-employment, routine or executive physicals, travel, recruitment to armed forces, insurance purposes, disability evaluations, or other administrative examinations is not a covered benefit under most Cigna standard plans

Screening for administrative reasons is excluded

inv-05: Diagnostic and Serologic Testing — Medically Necessary When Criteria Met

Considered medically necessary when criteria in the applicable policy statements listed above are met:

Diagnostic antigen/molecular tests: Testing codes such as 87426, 87428, 87635, 87811, U0001, U0002 are considered medically necessary when used to diagnose current infection in individuals with symptoms or with known/suspected exposure per policy criteria

See policy sections for exact clinical indications and required documentation.

Serologic (Antibody) testing: Codes 86328, 86408, 86409, 86413, 86769, 0224U are considered medically necessary when criteria in the applicable policy statements are met (e.g., timing relative to symptom onset or to document prior infection or in specific conditions such as MIS-C)3-5 weeks post symptom onset for evidence of prior infection per guideline references

IDSA and CDC guidance referenced; serology not for acute diagnosis within first 14 days.

inv-06: Not Covered — Surveillance, Screening and Administrative Testing

Testing is not covered when used for population/public health surveillance or many non-diagnostic administrative purposes:

Surveillance and non-diagnostic purposes: Testing performed for surveillance (population-level sampling) or for return-to-work, return-to-school, participation in sports, pre-employment, routine physicals, travel, insurance, disability evaluation, administrative exams, recruitment to armed forces and similar administrative reasons is not covered; surveillance testing involves de-identified specimens and cannot be used for individual healthcare decisions

Surveillance testing is intended for population-level monitoring and is not regulated by FDA in the same way as diagnostic testing

inv-07: Not Covered — Genotyping and Surrogate Neutralization

The following tests are explicitly not covered or reimbursable:

Genotype and sVNT exclusion: 87913 (infectious agent genotype analysis / SARS-CoV-2 mutation identification) and 0226U (surrogate viral neutralization test, sVNT) are Not Covered or Reimbursable

These tests are surveillance/variant-related and excluded from coverage

Surrogate viral neutralization assays and in vitro variant-determination tests are expressly listed as Not Covered or Reimbursable. Examples include the surrogate viral neutralization ELISA described by PLA code 0226U and SARS‑CoV‑2 genotype/mutation identification procedures such as 87913. Over‑the‑counter (OTC) SARS‑CoV‑2 tests are also not covered. These exclusions apply when the testing is performed for purposes other than individualized diagnosis or treatment (for example, population surveillance, prevalence studies, or administrative screening).

Testing performed solely for administrative or screening reasons is not a covered benefit under most Cigna standard plans. Examples include testing conducted for return‑to‑work, return‑to‑school, pre‑employment, participation in sports, routine or executive physicals, travel, insurance, disability evaluations, and other administrative examinations (see ICD‑10 Z02.* series).

Population‑level surveillance and public health screening (random sampling to estimate prevalence or trends) are considered non‑diagnostic and are not covered. Tests intended primarily to identify variants or perform viral genotyping for surveillance purposes (e.g., tracking emerging variants) are excluded from coverage; procedure codes such as 87913 (genotype/mutation identification) are specifically listed as not covered.

Specific procedure and reporting codes are identified as not covered when used in non‑diagnostic contexts. Notable examples include PLA/CPT 87913 (SARS‑CoV‑2 genotype/mutation identification) and PLA 0226U (surrogate viral neutralization test). In addition, unlisted/sundry reporting codes such as 99199 and E1399 may be used to report non‑diagnostic devices/tests (e.g., certain proprietary point‑of‑care products) and are similarly non‑reimbursable. Administrative encounter ICD‑10 codes in the Z02.* series are listed as not covered when used to report SARS‑CoV‑2 testing for administrative purposes.

Screening purposes, OTC tests, and assays intended to identify variants or provide non‑diagnostic results are excluded from coverage. The policy explicitly states that an OTC SARS‑CoV‑2 test is not covered or reimbursable and that tests described as not diagnostic (for example, certain proprietary point‑of‑care devices) are not covered. Variant identification and surrogate neutralization assays (e.g., 87913, 0226U) are excluded.

Routine NAAT (molecular) screening of asymptomatic individuals without known exposure — including routine pre‑procedure or pre‑admission testing in those without exposure risk — is not routinely recommended by guideline panels and is not covered when ordered for asymptomatic persons without clinical or epidemiologic justification. The IDSA guidance cited in the policy recommends against routine NAAT for asymptomatic persons without known exposure and discourages routine repeat NAAT to guide release from isolation or before procedures in this population.

Claims submitted with screening encounter diagnosis codes such as Z11.52 (screening for COVID‑19) or Z11.59, and exposure/contact codes Z20.822 or Z20.828, are listed as Not Covered or Reimbursable when used to report non‑diagnostic screening or surveillance testing. Use of these codes for testing intended primarily for population surveillance or administrative purposes may result in denial.

The policy calls out examples of non‑diagnostic tests and devices that are not covered when used to report SARS‑CoV‑2 testing. Proprietary or point‑of‑care products described as not diagnostic (for example, certain named devices or kits) and tests reported using unlisted/sundry codes (99199, E1399) are not reimbursable under standard benefit language.

Covered Indications and Diagnostic Uses

inv-57: Diagnosis of symptomatic individuals suspected of COVID-19 using NAAT; antigen testing for symptomatic persons with NAAT confirmation of negative results when indicated; serology to aid diagnosis of MIS-C/MIS-A or to document prior infection/exposure.

NAAT and Antigen Diagnostic Pathway: Use NAAT (molecular) testing for symptomatic individuals suspected of COVID-19 and for asymptomatic individuals with known or suspected exposure; antigen testing may be used in symptomatic persons but a negative antigen in a symptomatic person should be confirmed with an FDA-authorized NAAT; testing should be interpreted with clinical correlation and may require confirmatory NAAT

IDSA and CDC recommendations referenced

Serology for MIS-C/MIS-A and prior infection: Serologic testing may aid diagnosis of MIS-C or MIS-A, or to document prior infection/exposure when molecular/antigen tests are non-diagnostic; interpret serology in clinical context

Timing considerations (e.g., several weeks post-infection) apply

inv-58: Diagnosis of current SARS-CoV-2 infection in symptomatic individuals or those with known/suspected exposure; serologic testing to document prior infection or in specific conditions (e.g., MIS-C, post-COVID condition) per policy criteria.

Diagnosis of current infection: Diagnosis of current SARS-CoV-2 infection in symptomatic individuals or those with known/suspected exposure is supported by covered NAAT and antigen CPT/HCPCS codes when policy criteria are met

Submit appropriate diagnosis and documentation to support medical necessity

Serology for specific conditions: Serologic testing to document prior infection or in specific conditions (e.g., MIS-C, post-COVID condition) is covered when criteria are met and when billed with appropriate antibody CPT/PLA codes (e.g., 86328, 86408, 86409, 86413, 86769, 0224U)

See policy for allowed timing and clinical indications

Billing and Coding (CPT / HCPCS / ICD‑10)

Example ICD-10 codes for screening/workplace/administrative contextsICD-10Not Covered

Z02.79	Testing conducted to screen for general workplace health and safety
Z02.0	Return-to-school
Z02.5	Participation in sports
Z02.1	Pre-employment
Z02.89	Routine and/or executive physicals
Z02.3	Recruitment to armed forces
Z02.6	Insurance purposes
Z02.71	Disability evaluation
Z02.9	Encounter for administrative exam, unspecified

Covered diagnostic antigen and molecular CPT CodesCPTCovered

87426	Infectious agent antigen detection by immunoassay technique; SARS-CoV-2
87428	Infectious agent antigen detection by immunoassay technique; SARS-CoV-2 and influenza A/B
87635	Infectious agent detection by nucleic acid; SARS-CoV-2, amplified probe technique
87811	Infectious agent antigen detection by immunoassay with direct optical observation; SARS-CoV-2

CDC/Non-CDC RT-PCR HCPCS CodesHCPCSCovered

U0001	CDC 2019 Novel Coronavirus Real-Time RT-PCR Diagnostic Panel
U0002	2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV, any technique, multiple types or subtypes

Covered antibody (serology) CPT/PLA CodesCPT | PLACovered

86328	Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative; SARS-CoV-2
86408	Neutralizing antibody, SARS-CoV-2; screen
86409	Neutralizing antibody, SARS-CoV-2; titer
86413	SARS-CoV-2 antibody, quantitative
86769	Antibody; SARS-CoV-2
0224U	Antibody, SARS-CoV-2, includes titer(s), when performed

Not Covered testsCPT | PLANot Covered

87913	Infectious agent genotype analysis by nucleic acid; SARS-CoV-2 mutation identification in targeted region(s)
0226U	Surrogate viral neutralization test (sVNT), SARS-CoV-2, ELISA

Not Covered Procedure CodesCPT | HCPCSNot Covered

87913	Infectious agent genotype analysis by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) (COVID‑19), mutation identification in targeted region(s).
0226U	Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) (COVID‑19), ELISA, plasma, serum

Not Covered ICD-10 Codes (Administrative encounters)ICD-10Not Covered

Z02.0	Encounter for examination for admission to educational institution.
Z02.1	Encounter for pre‑employment examination.
Z02.3	Encounter for examination for recruitment to armed forces.
Z02.5	Encounter for examination for participation in sport.
Z02.6	Encounter for examination for insurance purposes.
Z02.71	Encounter for disability determination.
Z02.79	Encounter for issue of other medical certificate.
Z02.89	Encounter for other administrative examinations.
Z02.9	Encounter for administrative examinations, unspecified.

Not Covered When Used to Report Non‑Diagnostic SARS‑CoV‑2 TestsCPT | HCPCSNot Covered

99199	Unlisted special service, procedure or report.
E1399	Durable medical equipment, miscellaneous.

Not Covered ICD‑10 — placeholderICD-10Not Covered

All other codes

Referenced in context of Not Covered or Reimbursable ICD‑10 list (placeholder)

inv-26: Analytical sensitivity (LOD) — FDA nonbinding recommendation: 95% (LOD defined as >=19/20 positive replicates)

Analytical sensitivity (LOD)FDA nonbinding recommendation: 95% detection (LOD defined as the lowest concentration where >=19 of 20 viral replicates are positive).

Reported laboratory performanceMost test developers self-report high performance with reported results ranging from 95–100% in FDA submissions.

LOD purposeLOD describes the lowest concentration the assay can reliably detect under analytical validation; used in EUA/validation expectations.

inv-27: C-reactive protein threshold for MIS-C — >= 3.0 mg/dL (30 mg/L)

CRP threshold for MIS-C>= 3.0 mg/dL (30 mg/L).

Context of useIncluded as laboratory evidence of systemic inflammation in CDC/CSTE MIS-C case definition used to support diagnosis when molecular/antigen tests are non-diagnostic.

Interpretation noteSerology may aid diagnosis of MIS-C but results must be interpreted with clinical context and treatment history.

inv-28: Low community prevalence threshold used by IDSA — < 2%

IDSA low community prevalence threshold< 2% (used to define low prevalence when advising against routine NAAT in asymptomatic hospitalized individuals).

ImplicationWhen community prevalence is <2%, IDSA suggests routine NAAT in asymptomatic individuals without exposure is not recommended.

Source guidanceThreshold referenced in IDSA recommendations on routine testing and peri-procedure/repeat testing decisions.

Provider Actions, Prior Authorization, and Billing Notes

Prior Authorization

Prior authorization & coding note

Tests must meet medical necessity criteria and CLIA/FDA requirements. Claims submitted without covered diagnosis or procedure codes or for tests that do not meet criteria will be denied.

Provider must order and administer tests; use the most appropriate codes as of date of service.
Tests must be FDA approved/cleared or have an EUA and be performed per CLIA requirements (high/medium complexity or CLIA-waived as directed).
Document clinical rationale and diagnostic/serologic indication when submitting claims.

Prior Authorization

Prior authorization not applicable for non-covered screening

Population or public health screening and other non-diagnostic testing are not covered or reimbursable. Prior authorization is not applicable to claims for these non-covered screening indications.

Examples: asymptomatic screening (with or without exposure), general population screening, public health surveillance, workplace/school screening, return-to-work/school, participation in sports, pre-employment, travel, routine physicals, congregate setting screening.

Prior Authorization

Prior authorization / code-level coverage

Coverage of specific CPT/HCPCS/PLA codes requires that the test meet the medical necessity criteria in this policy. Listed covered codes are considered when all clinical criteria are met.

Covered codes include, when criteria met: 87426, 87428, 87635, 87811 (antigen/molecular) and 86328, 86408, 86409, 86413, 86769, 0224U (antibody).
Tests for variants are not covered unless meeting applicable criteria (see policy).

Prior Authorization

Prior authorization not applicable to listed not‑covered test codes

The listed not-covered test codes will not be covered regardless of prior authorization. Prior authorization does not change coverage for these specific codes.

Not covered codes include: 87913, 0226U.
Unlisted/sundry codes (e.g., 99199, E1399) submitted for non-diagnostic SARS-CoV-2 tests are not covered.

Denial Risk

Denial triggers

Claims will be denied as not covered if services are submitted without covered diagnosis or procedure codes or when testing does not meet the policy criteria.

Claims lacking a covered diagnosis/procedure code will be denied.
Over-the-counter (OTC) and non-diagnostic tests (e.g., tests not intended for diagnosis) are not reimbursable.

Denial Risk

Denial risk for screening/surveillance

Claims with screening encounter diagnosis codes or exposure/contact codes indicating screening, surveillance, or administrative testing are at high risk for denial.

Examples of diagnosis codes associated with denial risk: Z11.52, Z11.59 (screening encounters).
Exposure/contact-related codes that may trigger denial when used with SARS‑CoV‑2 test codes: Z20.822, Z20.828.

Denial Risk

Denial triggers for not covered test codes

Claims submitted with procedure codes listed as not covered will be denied. Use covered codes only when medical necessity criteria are met.

Not covered procedure codes include: 87913, 0226U, and unlisted codes used to report non-diagnostic SARS-CoV-2 tests (e.g., 99199, E1399).
Administrative encounter ICD-10 Z02.* codes indicate non-diagnostic exams and are generally not covered for SARS‑CoV‑2 testing.

Documentation Required

Ordering and performance requirements

Provider must order and perform tests; use the most appropriate CPT/HCPCS codes for the date of service. Tests must be FDA approved/cleared or have an EUA and be performed per CLIA requirements.

Tests must be performed by CLIA-certified high- or medium-complexity labs or CLIA-waived labs if directed by the test Instructions for Use.
Providers should follow test-specific Instructions for Use regarding specimen type and performance setting.

Documentation Required

Clinical correlation required

Clinical correlation with patient history and other diagnostic information is required. Negative antigen or molecular results should not be used as the sole basis for patient management decisions.

Positive results do not rule out co-infection; negative results do not preclude infection and must be interpreted with clinical context.
Combine test results with clinical observations, patient history, and epidemiologic information when documenting medical necessity.

Documentation Required

Administrative encounter documentation

Use administrative encounter ICD-10 Z02.* codes for non-diagnostic administrative exams when appropriate; note these encounters are generally not covered for SARS‑CoV‑2 testing under standard benefit plans.

Examples: Z02.0 (admission to educational institution), Z02.1 (pre-employment), Z02.5 (participation in sport), Z02.6 (insurance purposes), Z02.79, Z02.89, Z02.9.

Note

Repeat/confirmatory testing guidance

When an antigen test is negative in a symptomatic person, repeat antigen testing after 48 hours or obtain a NAAT (PCR) as recommended; follow CDC/IDSA guidance when confirmatory testing is indicated.

If antigen negative with symptoms: repeat antigen after 48 hours or perform a PCR/NAAT.
Antigen positives in symptomatic individuals are generally considered reliable; negatives may require confirmatory NAAT per CDC algorithm.

Note

Confirmatory NAAT after negative antigen in symptomatic

In symptomatic individuals with a negative antigen result, obtain a confirmatory NAAT (PCR) before excluding infection; use assays evaluated for analytical sensitivity per CDC recommendations.

NAAT is recommended in symptomatic individuals suspected of having COVID-19.
Select NAATs that have been evaluated against FDA reference panels for analytical sensitivity when available.

Ordering Requirements and Test Use

Documentation Required

Tests require licensed/authorized provider order and correct billing

Tests must be ordered and administered by a licensed or authorized healthcare provider; providers must use appropriate billing codes and follow plan‑specific benefit documents when submitting claims.

Ordering and administration must be by a licensed/authorized provider.
When billing, use the most appropriate codes as of the date of service and follow the member's benefit plan terms.

Documentation Required

Order tests based on clinical presentation; repeat/confirm antigen negatives

Order tests in the context of the patient's clinical presentation: antigen positives in symptomatic persons are acceptable, but antigen negatives in symptomatic persons should be repeated after 48 hours or confirmed with NAAT when clinically indicated.

CDC recommends repeating an antigen test after 48 hours or obtaining a PCR if the initial antigen is negative in a symptomatic person.
Document symptom status and timing of tests to support medical necessity.

Documentation Required

Order diagnostic tests for symptoms/exposure; use serology per policy

Diagnostic testing should be ordered for symptomatic individuals or asymptomatic individuals with known or suspected exposure; serologic testing should be ordered only per policy criteria (e.g., to aid diagnosis of MIS‑C/MIS‑A or document prior infection) and in appropriate timing (e.g., weeks after symptom onset).

NAAT is recommended for symptomatic individuals and suggested for asymptomatic individuals with known/suspected exposure per IDSA/CDC guidance.
Serology is not for acute diagnosis and should be used according to policy criteria (for example, to aid MIS‑C diagnosis or document prior infection at appropriate post‑infection timing).

Definitions and Test Types

inv-46: Molecular testing — Molecular test (NAAT/PCR) definition and notes

DefinitionMolecular tests (NAAT/PCR) detect SARS-CoV-2 genetic material (RNA) using nucleic acid amplification techniques.

Clinical roleNAAT/PCR are the 'gold standard' for diagnosing active infection and are highly analytically sensitive under controlled conditions.

Laboratory requirementsMolecular tests used diagnostically must be FDA approved/cleared or have EUA and be performed in CLIA-certified laboratories per Instructions for Use.

inv-47: Antigen testing — Antigen test definition; detect viral proteins; repeat if negative in symptomatic individuals

DefinitionAntigen tests detect viral proteins (pieces of the virus) and can be used at point-of-care or at-home for diagnostic purposes.

Performance noteA positive antigen test is generally reliable in symptomatic persons, but a negative antigen in symptomatic individuals should be repeated after 48 hours or confirmed by NAAT.

Recommended useAntigen tests are useful for quick, point-of-care detection and for serial screening programs in certain high-risk settings per CDC guidance.

inv-48: Antibody (serology) testing — Detects antibodies to SARS-CoV-2; not for diagnosing active infection or assessing vaccine need/immunity

DefinitionAntibody (serology) tests detect host antibodies to SARS-CoV-2 (e.g., IgG, IgM, total antibodies) in blood.

Clinical limitationSerology is not used to diagnose active infection and should not be used to assess post-vaccination immunity; it may aid diagnosis of MIS-C/MIS-A or document prior infection.

Timing considerationsSerologic testing for prior infection is most informative weeks after symptom onset (e.g., 3–5 weeks) and results require clinical correlation.

inv-49: Limit of Detection (LOD) — Lowest concentration with >=19/20 positives; FDA nonbinding standard recommends 95% detection

DefinitionLimit of Detection (LOD): the lowest concentration at which at least 19 of 20 viral replicates are positive; FDA nonbinding standard recommends 95% detection.

Use in validationLOD is a key analytical validation metric referenced in FDA EUA submissions and laboratory validation expectations.

Impact on sensitivityA stricter LOD requirement supports higher analytical sensitivity but clinical sensitivity also depends on timing, specimen quality, and handling.

inv-50: Pooled testing — Definition and use to conserve resources; negative pooled result infers negatives for contributors

DefinitionPooled testing combines specimens from multiple individuals into a single batch to conserve resources; a negative pooled result implies contributors are presumptively negative.

LimitationsPooling dilutes specimens and can reduce sensitivity; positive or inconclusive pools require individual retesting.

Appropriate useMay be useful in low-prevalence populations but not appropriate in high-prevalence settings due to increased need for individual retesting.

inv-51: MIS-C / MIS-A — Definitions and relation to serologic testing

DefinitionMIS-C and MIS-A are multisystem inflammatory syndromes temporally associated with prior SARS-CoV-2 infection; serology can aid diagnosis when molecular/antigen tests are non-diagnostic.

Clinical criteriaCDC/CSTE case definitions include systemic inflammation markers and organ involvement; serology may support evidence of recent or prior infection.

Testing roleSerology is considered when molecular tests are negative or non-diagnostic in suspected MIS and results must be interpreted with clinical context.

inv-52: Surveillance testing — Definition and characteristics (population/public-health testing with de-identified specimens)

DefinitionSurveillance testing: population/public-health testing using de-identified specimens to monitor incidence/prevalence; results are not returned to individuals and not used for individual healthcare decisions.

Regulatory noteSurveillance testing often does not meet FDA/CLIA diagnostic requirements and is intended for population-level monitoring rather than individual diagnosis.

Example usesRandom sampling by public health departments to estimate community infection rates or evaluate interventions.

inv-53: Diagnostic testing — Definition for viral tests (NAATs, antigen tests) for current infection in symptomatic or exposed individuals

DefinitionDiagnostic testing refers to viral tests (NAATs, antigen tests) performed to identify current SARS-CoV-2 infection in symptomatic individuals or those with known/suspected exposure.

Intended useDiagnostic tests inform clinical management, isolation decisions, and require clinical correlation with history and epidemiologic information.

Test examplesIncludes NAAT/PCR and antigen tests used per CDC/IDSA guidance for symptomatic and exposed individuals.

inv-54: Infectious agent genotype analysis — 87913 (definition/label)

Definition/Label87913: Infectious agent genotype analysis by nucleic acid; SARS‑CoV‑2 mutation identification in targeted region(s).

Coverage stanceThis procedure code is explicitly listed as Not Covered or Reimbursable for variant/genotype testing in this policy excerpt.

inv-55: Surrogate viral neutralization test (sVNT) — 0226U (definition/label)

Definition/Label0226U: Surrogate viral neutralization test (sVNT), SARS‑CoV‑2, ELISA, plasma/serum.

Coverage stanceThis PLA/HCPCS code is explicitly listed as Not Covered or Reimbursable in the policy excerpt.

OpenPayer

COVID-19: In Vitro Diagnostic Testing

Coverage Criteria for SARS-CoV-2 Testing

Covered Indications and Diagnostic Uses

Billing and Coding (CPT / HCPCS / ICD‑10)

Provider Actions, Prior Authorization, and Billing Notes

Ordering Requirements and Test Use

Frequency and Repeat Testing Guidance

Explicitly Not Covered Services

Definitions and Test Types

Background

Policy Revision History