Updated Guidance on COVID-19 Testing Coverage Requirements

On February 26, 2021, the U.S. Departments of Health Services, Labor, and the Treasury jointly issued guidance clarifying coverage requirements for diagnostic COVID-19 testing.

The additional guidance was provided in the form of frequently asked questions (FAQs).  The new FAQs respond to questions regarding use of medical screening criteria, location of testing sites, and coverage for asymptomatic individuals. Specifically, the FAQs provide the following guidance:

  • Insurers cannot require the presence of symptoms or a recent known or suspected exposure or use medical screening criteria to deny a claim for COVID-19 diagnostic testing.
  • Insurers must cover the test without cost sharing (including deductibles, copayments, and coinsurance), prior authorization, or other medical management requirements.
  • Insurers must assume that the receipt of the COVID-19 test reflects an “individual clinical assessment” when an individual seeks and receives a COVID-19 diagnostic test or is referred for a COVID-19 diagnostic test from a health care provider including individuals who are asymptomatic or without known or suspected exposure.
  • Insurers are required to cover COVID-19 diagnostic tests provided through state or locally administered testing sites, including “drive-through” testing sites when the purpose of the testing is for individualized diagnosis.
  • Insurers are required to cover COVID-19 diagnostic tests including point-of-care or “rapid” tests provided the test meets one of the criteria established in the FFCRA section 6001 (a) (1), as amended by section 3201 of the CARES Act.