COVID-19 vaccine billing
For vaccine billing, administration codes, and more information, please refer to our COVID-19 Temporary payment policy.
FDA-approved pharmaceutical treatment
Blue Cross covers drugs with FDA-approval and those with Emergency Use Authorization for COVID-19 at no cost to our members. For more information on pharmaceutical treatment, please refer to our COVID-19 Temporary payment policy.
Investigational drugs
Covered investigational drugs
Blue Cross covers the antiviral therapy and immunomodulators when used outside a clinical trial for patients who are in an inpatient hospital setting and require treatment beyond respiratory support. This is at the discretion of their treating provider.
Non-covered investigational drugs
Blue Cross does not cover drugs that have not demonstrated improvement in patient outcomes or are not recommended for use outside of the clinical trial setting by the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), or Department of Public Health (DPH) guidelines. The following drugs are not covered outside of the clinical trial setting:
Cognitive rehabilitation
Per state mandate Chapter 260 of the Acts of 2020—Patients First Act, cognitive rehabilitation for cognitive impairment resulting from COVID-19 is covered in the outpatient setting. Providers should document all the following for coverage:
Inpatient cognitive rehabilitation is covered when the patient meets the inpatient level of care criteria. For more details, see our medical policy 660: Cognitive Rehabilitation.
FDA-approved pharmaceutical treatment
Blue Cross covers drugs with FDA-approval and those with Emergency Use Authorization for COVID-19 at no cost to our members throughout the duration of the public health emergency. For more information on pharmaceutical treatment, please refer to our COVID-19 Temporary payment policy.
Investigational drugs
Covered investigational drugs
Several drugs that have shown early benefit in clinical trials are under investigation as potential treatments for COVID-19. Blue Cross covers the antiviral therapy and immunomodulators when used outside a clinical trial for patients who are in an inpatient hospital setting and require treatment beyond respiratory support. This is at the discretion of their treating provider.
Non-covered investigational drugs
Blue Cross does not cover drugs that have not demonstrated improvement in patient outcomes in early studies or are not recommended for use outside of the clinical trial setting by the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), or Department of Public Health (DPH) guidelines. The following drugs are not covered outside of the clinical trial setting:
Cognitive rehabilitation
Per state mandate Chapter 260 of the Acts of 2020—Patients First Act, cognitive rehabilitation for cognitive impairment resulting from COVID-19 is covered in the outpatient setting. Providers should document all of the following for coverage:
Provider-ordered COVID-19 tests
What’s covered
Blue Cross covers:
All covered tests must be FDA-approved or have Emergency Use Authorization, or the developer must have requested, or intends to request Emergency Use Authorization.
Please note: The ordering clinician NPI is a required field on your claim to indicate that the lab test is medically necessary.
What’s not covered
PCR or antigen testing and serological testing are not covered for:
At-home tests
We do not cover self-administered at-home tests. Members may use their Flexible Spending Account or Health Savings Account to pay for the tests.
Provider-ordered COVID-19 tests
PCR or antigen tests
Medicare Part B (medical insurance) covers
PCR or antigen testing to diagnose COVID-19 infection when ordered by any health care professional authorized under state law.
Antibody testing
Serologic testing for the presence of antibodies for known or suspected current or prior COVID-19 infection is covered for FDA-approved tests when ordered by any health care professional authorized under state law.
At-home tests
We do not cover self-administered at-home tests. Members in Medicare PPO Blue SaverRx and Medicare HMO SaverRx can use their quarterly over-the-counter (OTC) allowance to purchase at-home tests at CVS.
We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for FEP members. Please refer to fepblue.org for up-to-date benefit information.
Coverage
We continue to pay for telehealth visits for primary care and chronic condition visits at the same rate as in-person visits. Our Telehealth – Medical Services and Telehealth - Mental Health payment policies detail coverage and billing guidelines. For more information, see our Telehealth page.
For Federal Employee Program (FEP) members, we are following guidelines from the Blue Cross Blue Shield Association regarding coverage for FEP members. Please refer to fepblue.org for up-to-date benefit information.
Adjustments to Medicare Advantage reimbursement
The Protecting Medicare and American Farmers from Sequester Cuts Act reinstated the Medicare payment adjustment known as “sequestration,” effective April 1, 2022. Beginning July 1, 2022, CMS applied a 2% payment adjustment. This policy update applies to all medical providers.
The Consolidated Appropriations Act (CAA) of 2023 extended the current 2% sequestration of Medicare spending into FY 2032 rather than expiring at the end of FY 2031. Enactment of the American Rescue Plan Act of 2021 (ARPA) triggered a 4% Medicare sequester under Statutory PAYGO for FY 2022 (along with across-the-board cuts in other mandatory spending). Congress delayed these cuts to January 1, 2023, then waived them for 2023 and 2024.
COVID-19 related care costs
For our commercial members
We cover copayments, co-insurance, and deductibles for all medically necessary COVID-19 related care at:
* Self-insured accounts design/customize their plans and benefits and may require inpatient cost share.
For Federal Employee Program members
We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for FEP members. Please refer to fepblue.org for up-to-date benefit information.
For our Medicare Advantage HMO Blue and PPO Blue, Managed Blue for Seniors, and Medex plan members
We cover costs related to medically necessary COVID-19 testing, counseling, vaccinations, and treatment at doctor’s offices, emergency rooms, and urgent care centers. This coverage follows Centers for Disease Control and Prevention (CDC) and Massachusetts Department of Public Health (DPH) guidelines.
Throughout the public health emergency, we paid all Medicare Advantage claims at the member’s in-network level of benefits and waived HMO referral requirements. Starting January 1, 2024, we will revert to our standard referral requirements for Medicare Advantage HMO members and pay out-of-network claims according to the member’s out-of-network benefits.
Inpatient and outpatient observation level of care for COVID-19 diagnoses
We waive member costs for medically necessary inpatient and outpatient level of care hospital services when the claim includes a COVID-19 diagnosis. This applies to in- and out-of-network services.
We do not waive member cost for care received in skilled nursing facilities. This policy applies to all Blue Cross Blue Shield of Massachusetts members.
Note: Employers who are self-insured may choose to waive costs for their employees.
*Blue Plan members receiving care in Massachusetts are covered according to their Home plan’s benefits and coverage.
Member questions
Members can call our dedicated coronavirus help line at 1-888-372-1970.
Payment policy
Contact us
Network Management and Credentialing Services
1-800-316-BLUE (2583)
Dental Network Management
1-800-882-1178
Links & resources