CMS: Group health plans must cover COVID-19 diagnostic testing

The Biden administration on Friday made clear that private group health plans and issuers cannot deny coverage or impose cost-sharing for COVID-19 diagnostic testing, regardless of whether the patient is experiencing symptoms or has been exposed to the virus.

According to CMS, the new guidance should make it easier for people to access COVID-19 diagnostic testing. For instance, the agency said people can get tested for COVID-19 before visiting a family member and pay no additional out-of-pocket costs. The guidance also instructs providers on how to get reimbursed for diagnostic testing or administering COVID-19 vaccines to people without health coverage.

“Plans and issuers are prohibited from requiring prior authorization or other medical management for COVID-19 diagnostic testing,” CMS said in a statement.

Providers can get reimbursed for COVID-19 diagnostic testing and vaccine administration through the Health Resources and Services Administration COVID-19 Uninsured Program, part of the Provider Relief Fund.

“To further build awareness about the availability of this program, this announcement seeks comment on strategies to connect those without insurance to care from providers participating in this fund,” CMS said in a statement.


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