Reminder: Billing for COVID-19 testing

With the increase in COVID-19 cases that we’re seeing across Michigan and the United States, we want to remind our health care providers about Blue Cross Blue Shield of Michigan and Blue Care Network’s policy when it comes to COVID-19 testing.

Blue Cross and BCN will cover the cost of COVID-19 testing for members that:

• Is ordered by a qualified health professional who determines testing is medically appropriate, using judgment in accordance with accepted standards of current medical practice; and
• Has met the necessary regulatory approval through the FDA or falls within one of the other categories of tests required to be covered by the Families First or CARES acts.

The test orders must show medical necessity. The only exception is for patients with Medicare Advantage coverage who are allowed one COVID-19 test without an order from a health professional in accordance with the Centers of Medicare & Medicaid Services policy.

Blue Cross and BCN cover pre-operative COVID-19 testing for procedures conducted in hospital operating rooms and ambulatory surgical facilities. Aerosol-generating procedures are also appropriate for pre-operative COVID-19 testing, regardless of the location performed, such as oral surgery in an office setting.

It’s important to note that Blue Cross and BCN policy does not cover workplace or screening tests, such as testing to:

• Participate in sports
• Return to work or school
• Qualify for admission to armed services, residential facilities, etc.
• Engage in research
• Accommodate requests for routine testing due to general concerns or a desire to get tested prior to family gatherings, vacations, etc. 

If a patient wants to get testing that their health plan won’t cover, you can direct them to Michigan.gov/coronavirus** to find a site that offers free COVID-19 testing.

For more information, see the COVID-19 patient testing recommendations document. It’s available on our public website at bcbsm.com/coronavirus and by logging in as a provider at bcbsm.com and clicking on Coronavirus (COVID-19).

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.