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The end of the COVID-19 public health emergency (PHE): important changes to testing access and reimbursement

The end of the COVID-19 public health emergency (PHE) will greatly impact costs and accessibility for SARS-CoV-2 (COVID-19) testing. We’re here to help you navigate new policies and support you with quality, affordable testing solutions for patients.

Post-PHE COVID-19 testing changes for providers and patients1-3

While every plan’s requirements and guidelines for COVID-19 testing may vary,  below is a summary of key changes for you, your staff, and your patients to be aware of:

  • Private health insurance companies are no longer required to provide free COVID-19 tests
  • Many insurance companies are including testing as a benefit, but members may be responsible for paying their copay or a deductible based on their benefit plana
  • If the member uses an out-of-network lab, they may incur additional out-of-pocket costs
  • Retail testing (ie, pharmacy) may not be available and patient-initiated testing may not be covered
  • Many insurance companies are requiring patients to be symptomatic in order for testing to be covered as a plan benefit.a Including relevant ICD-10 codes associated with symptoms may better inform coverage decisions

a Coverage may vary within individual insurance plans.

  • Medicare enrollees may still be eligible for free testing for a limited time2-3
  • Testing must be ordered by a healthcare provider

  • State Medicaid programs must provide free COVID-19 tests through September 2024, after which time coverage will vary by state
  • Temporary Medicaid coverage option for uninsured patients that provided free COVID-19 testing will end

For commonly asked questions regarding the end of the PHE, view our FAQ

View our FAQ

Continuing to support you and your patients with COVID-19 testing

Respiratory illnesses persist year-round—and symptoms overlap—which can make it challenging to confirm a diagnosis. We offer a comprehensive portfolio of COVID-19 testing, including NAAT and respiratory molecular combination tests, which use a single specimen to test for COVID-19 and common respiratory viruses.

For patients who are in your office for COVID-19 testing, send the collected sample to Quest for timely, accurate results that can help with a faster diagnosis so that you can develop an appropriate care plan.
Post-PHE testing information

Sending a patient to Quest for collection

To help you spend more time seeing patients for routine or acute care, and less time on specimen collection, supervised self-collection for COVID-19 testing is available at many local Patient Service Centers (PSCs).b With convenient locations and easy-to-schedule online appointments, we make it simple for patients to get the testing you’ve ordered.

Results are easily accessible via Quanum® (and for patients, via our free MyQuest® patient portal), so you can initiate timely treatment and  patients can access their test result as soon as it’s ready.

If you already order testing for your patients electronically, the process is the same. Here’s how it works:

1. Ensure the test codes you need are mapped in your EHR

2. Choose the COVID-19 or COVID-19+Flu test code you need, and be sure to include appropriate ICD-10 codes

3. Have your patient find the collection site that is best for them and schedule an appointment

Test name Test ordering
SARS-CoV-2 RNA (COVID-19), Qualitative NAAT Patients will need a test order from their healthcare provider for testing with corresponding ICD-10 codes
SARS-CoV-2 RNA (COVID-19) and Influenza A and B, Qualitative NAAT Patients will need a test order from their healthcare provider for testing with corresponding ICD-10 codes
b Supervised self-collection is not available in the following states due to state regulations: AL, AZ, DE, HI, KY, LA, ME, MN, MS, MT, ND, OK, RI, UT, VT, WA, and WY. Supervised self-collection may be available only at select Patient Service Centers in all other states. Contact your Quest representative for a list of Patient Service Centers offering supervised self-collection in those states.

Protect your patients from unexpected costs

With patients now facing out-of-pocket costs for COVID-19 testing, it’s imperative to send your patients to an in-network lab like Quest to help them save money.

c This is directional data. It is based on 2020 HealthLeaders membership data of private third-party payers at the Managed Care Organization (MCO) level, as well as Quest internal data. Information is believed to be accurate as of January 1, 2020; however, it is subject to change. Does not include Kaiser Permanente access data.

Is COVID-19 testing still free for my patients?

  • Private health insurance companies are no longer required to provide free tests1-3
  • Medicaid and Medicare enrollees may still be eligible for free testing for a limited time1-3

How can I help ensure testing will be covered by my patients’ insurance?

To help control patient out-of-pocket costs, here are some key tips to remember:

  • Many health plans are including testing as a benefit, but members may be responsible for paying their copay or a deductible based on their benefit plana—and testing must be performed by an in-network lab
  • Quest is in-network with 90% of insured lives nationwide, which can help keep out-of-pocket costs low for your patientsc
  • Healthcare provider must submit the test order and include appropriate ICD-10 codes
  • Many plans are requiring patients to be symptomatic for testing to be covereda

Will Quest still offer COVID-19 testing?

We are committed to supporting you and your patients with a complete portfolio of COVID-19 tests, including molecular laboratory tests and respiratory combination tests, which use a single specimen to test for COVID-19 and other respiratory pathogens.

How can my patients get tested?

Testing is no longer available at retail sites (ie, pharmacies). For sick patients who are in your office for testing, you can send the collected sample to Quest, or, you can consider sending an order to a Quest Patient Service Center for supervised self-collection.b

a Coverage may vary within individual insurance plans.
b Supervised self-collection is not available in the following states due to state regulations: AL, AZ, DE, HI, KY, LA, ME, MN, MS, MT, ND, OK, RI, UT, VT, WA, and WY. Supervised self-collection may be available only at select Patient Service Centers in all other states. Contact your Quest representative for a list of Patient Service Centers offering supervised self-collection in those states.
c This is directional data. It is based on 2020 HealthLeaders membership data of private third-party payers at the Managed Care Organization (MCO) level, as well as Quest internal data. Information is believed to be accurate as of January 1, 2020; however, it is subject to change. Does not include Kaiser Permanente access data.


COVID-19 testing statements

  • The antibody tests and the molecular tests (together “All tests”) have not been FDA cleared or approved;
  • All tests have been authorized by FDA under EUAs for use by authorized laboratories;
  • The antibody tests have been authorized only for the detection of IgG antibodies against SARS-CoV-2, not for any other viruses or pathogens;
  • The molecular tests have been authorized only for the detection of nucleic acid from SARS-CoV-2, not for any other viruses, pathogens; and,
  • All tests are only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner.

References

  1. CMS. CMS waivers, flexibilities, and the transition forward from the COVID-19 public health emergency. February 27, 2023. Accessed March 27, 2023. https://www.cms.gov/newsroom/fact-sheets/cms-waivers-flexibilities-and-transition-forward-covid-19-public-health-emergency
  2. Cox C, Kates J, Cubanski J et al. The end of the COVID-19 public health emergency: details on health coverage and access. KFF. February 3, 2023. Accessed March 28, 2023. https://www.kff.org/policywatch/the-end-of-the-covid-19-public-health-emergency-details-on-health-coverage-and-access/
  3. Cox C, Kates J, Cubanski J et al. Commercialization of COVID-19 vaccines, treatments, and tests: implications for access and coverage. KFF. February 13, 2023. Accessed March 28, 2023. https://www.kff.org/coronavirus-covid-19/issue-brief/commercialization-of-covid-19-vaccines-treatments-and-tests-implications-for-access-and-coverage/

 

Questions?

For more information on our SARS-CoV-2 (COVID-19) testing solutions, or to set up a Quest account, connect with a Quest representative.

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