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March 05, 2021

Health Law Weekly

New Guidance Clarifies Insurer Coverage Requirements for COVID-19 Testing

  • March 05, 2021

Health insurers cannot use medical screening criteria to deny coverage for COVID-19 diagnostic tests for covered individuals who are asymptomatic and have no known suspected exposure to the virus under new guidance from the administration.

The guidance, issued by the Centers for Medicare & Medicaid Services (CMS) and Departments of Labor and Treasury, follows an executive order signed by President Biden in January to help ensure widespread access to COVID-19 testing.

The guidance makes clear that health plans must cover COVID-19 testing without cost sharing, prior authorization, or other medical management requirements, regardless of the reason the individual is seeking the test—for example, to ensure they don’t have the virus before visiting a family member, according to a CMS press release.

CMS said the guidance is intended to put to rest questions about whether private insurers must cover COVID-19 testing under federal law for individuals who are asymptomatic and have no known or suspected exposure to the virus.

The guidance also details how providers can seek federal reimbursement for COVID-19 testing or for administering the COVID-19 vaccine to those who are uninsured.