COVID-19 Testing Coverage Changes

COVID-19 Testing Coverage Changes


BlueCross BlueShield of South Carolina (BlueCross) and BlueChoice® HealthPlan updated the Notice of COVID-19 Benefit Plan Changes to reflect the new testing guidance we received from the Centers for Disease Control and Prevention (CDC), Department of Labor (DOL), Department of Health and Human Services (DHHS) and Department of the Treasury. This guidance addresses COVID-19 polymerase chain reaction (PCR) testing (including home test kits) and serology (antibody) testing coverage. These agencies also give guidance on making decisions based on the antibody test results.

COVID-19 Polymerase Chain Reaction (PCR) Testing (Including Home Test Kits) and Serology Testing

PCR diagnostic testing for COVID-19 is covered at no cost to members when ordered by an attending health care provider. The test must be provided at the point of care for individuals who are symptomatic and are concerned about infection. The test must also be ordered for the purpose of identifying and treating active disease.

Serology (antibody) testing and home test kits will be covered at no cost if:

  • A health care provider deems them medically necessary in accordance with accepted standards of current medical practice for a patient with COVID-19 symptoms or asymptomatic individuals with known or suspected recent exposure. 
  • Serology (antibody) testing is not used as a sole means of diagnosis of COVID-19 infection.

According to the CDC, antibody test results should NOT be used to assume immunity and therefore should not be used to make decisions about the use of personal protective equipment, returning to the workplace and forming groups of individuals. Per additional guidance jointly released by DOL, DHHS and the Department of the Treasury, public health and employment return-to-work testing are not medically necessary and will not be covered.

The revised notice and updated information regarding COVID-19 can be found on our websites for you and your customers who are our members.

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