Starting today, Medicare Part B beneficiaries, including those enrolled in a Medicare Advantage plan, will be able to request up to eight over-the-counter COVID-19 tests per calendar month at no cost. CMS will pay participating eligible pharmacies up to $12 per test ($24 for a box of two tests). Eligible pharmacies are those that are enrolled to bill Medicare for Part B ambulatory health care services such as vaccines, COVID-19 testing, and regular medical visits (i.e., pharmacy, independent clinical laboratory, or mass immunizer PTANs). Participation is voluntary, and no participation agreements are required. Pharmacies will be responsible for procuring the OTC COVID-19 tests which must be approved, authorized, or cleared by the FDA. To bill for providing over-the-counter COVID-19 tests you are required to submit claims using the applicable standard claim format (i.e., the 837 Professional or Institutional format; no roster bills). Refer to your medical billing intermediary for instructions to submit the necessary data. CMS established a new HCPCS Level II code, K1034, that is payable for a single test and is inclusive of all FDA-approved, authorized or cleared COVID-19 tests where the specimen is self-collected, and the test is self-administered by an individual. Be sure to ask individuals for their Medicare Red, White and Blue card. CMS will pay claims in the order they receive them. If a Medicare beneficiary has exceeded the per calendar month quantity limit, the claim will be rejected, and you may seek payment from the beneficiary for such tests. If you have questions, email [email protected].
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