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COVID-19 information for our clinical partners

 News & updates

April 13 What to know about the end of the COVID-19 public health emergency
August 8 Novavax approved as fourth COVID-19 vaccine
May 6 Authorization requirements previously relaxed to resume May 17
May 6 Remdesivir approved as treatment for kids under 12
April 16 Bebtelovimab fights COVID subvariant now dominant in Massachusetts


April 13 What to know about the end of the COVID-19 public health emergency
August 8 Novavax approved as fourth COVID-19 vaccine
May 6 Authorization requirements previously relaxed to resume May 17
May 6 Remdesivir approved as treatment for kids under 12
April 16 Bebtelovimab fights COVID subvariant now dominant in Massachusetts
March 16 COVID-19 treatments available across Massachusetts
March 11 Medicare sequestration to resume April 1, 2022
March 2 Auth requirements and credentialing procedures continue to be relaxed
February 10 New resources for at-home COVID-19 testing
January 31 At-home COVID test coverage for members began Jan 15 UPDATED!
January 27 FDA Changes: Some Monoclonal Antibody Treatments No Longer Covered
January 18 At-home COVID test coverage for members began Jan 15

+ 2021

+ 2020


 Vaccines and treatments

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:

  • Blood-derived products (such as SARS-CoV-2 immunoglobulins, mesenchymal stem cells)
  • Antiviral therapies or immunomodulators without published supporting evidence (such as lopinavir/ritonavir, and other HIV protease inhibitors)
  • Other therapies currently under investigation without published supporting evidence

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:

  • Cognitive impairments resulting from COVID-19 that were either clinically diagnosed or diagnosed through PCR/antigen testing 
  • Patient symptoms that impair daily functioning and are unlikely to resolve on their own over time 
  • Patient symptoms that are expected to improve with cognitive rehabilitation

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:

  • Blood-derived products (such as SARS-CoV-2 immunoglobulins, mesenchymal stem cells)
  • Antiviral therapies or immunomodulators without published supporting evidence (such as lopinavir/ritonavir, other HIV protease inhibitors)
Other therapies currently under investigation without published supporting evidence

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:

  • Cognitive impairments resulting from COVID-19 that were either clinically diagnosed or diagnosed through PCR/antigen testing 
  • Patient symptoms that impair daily functioning and are unlikely to resolve on their own over time 
  • Patient symptoms that are expected to improve with cognitive rehabilitation
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.

 Testing

Commercial members: HMO, POS, PPO, and Indemnity

Provider-ordered COVID-19 tests

What’s covered
Blue Cross covers:

  • Medically necessary reverse transcription-polymerase chain reaction (RT-PCR) or antigen testing to diagnose COVID-19 when ordered by a health care provider as part of an individualized assessment in accordance with current standards of medical practice and in accordance with CDC and MA Department of Public Health guidelines.
  • Symptomatic or asymptomatic patients who require testing prior to a medical procedure or surgery.
  • Admission to a facility – including but not limited to a hospital operated or licensed by the Department of Public Health and the Department of Mental Health, a long-term acute care hospital, or a skilled nursing facility.
  • Serologic testing for the presence of COVID-19 antibodies that are ordered by a health care provider according to CDC and MA Department of Public Health guidelines.

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:

  • General screening purposes (such as return-to-work, or attending school, day care, or camp)
  • Public health or surveillance purposes
  • Periodic or serial testing of asymptomatic individuals (examples include congregate housing, such as dormitories and residential facilities, and occupational safety)
    • Tests that have been denied FDA approval, an Emergency Use Authorization from the FDA, or laboratories that have not submitted an Emergency Use Authorization request within a reasonable timeframe
    • Member transportation to or from testing sites (unless the member meets requirements for ambulance services)
    • Screening eligibility to donate plasma (for serologic testing)

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.

Medicare Advantage members

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.

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.

 Telehealth (telephone calls and video visits)

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.

 Administrative changes & other updates

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.

 Member cost (copayments, co-insurance, and deductibles)

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:

  • Doctors' offices
  • Urgent care centers
  • Emergency departments
  • Both in- and out-of-network acute care facilities for our fully insured members*

* 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.

Contact us

Network Management and Credentialing Services
1-800-316-BLUE (2583)

Dental Network Management
1-800-882-1178

Links & resources