COVID-19 Testing and Cost Share Guidance

Last update: October 7, 2020, 4:40 p.m. CDT

UnitedHealthcare will cover COVID-19 testing for all lines of business, in accordance with the member's benefit plan.

Members should work with their provider to order a test. Additional member guidance on testing can be found here.

A virus detection diagnostic (molecular or antigen) test determines if a person is currently infected with COVID-19, while an antibody (serology) test may determine if a person has been exposed to COVID-19. 

Testing coverage may vary by health plan. Please review each section below for details. Dates are subject to change based on the national public health emergency period. 

  • Virus Detection Diagnostic (Molecular or Antigen) and Antibody Testing: UnitedHealthcare will cover medically appropriate COVID-19 testing for the following health plans at no cost share, when ordered by a physician or appropriately licensed health care professional for purposes of the diagnosis or treatment of an individual member:* 
    • Medicare Advantage
      Waiver of cost share is effective from Feb. 4, 2020, through the national public health emergency period, currently scheduled to end Jan. 20, 2021, for in-network and covered out-of-network tests.

    • Individual and Group Market health plans
      Waiver of cost share is effective from Feb. 4, 2020, through the national public health emergency period, currently scheduled to end Jan. 20, 2021, for in-network and out-of-network tests.

    • Medicaid
      Waiver of cost share is subject to state regulations. 

UnitedHealthcare will cover testing for employment, education, public health or surveillance purposes when required by applicable law. Benefits will be adjudicated in accordance with a member’s benefit plan; health benefit plans generally do not cover testing for surveillance or public health purposes. We continue to monitor regulatory developments during emergency periods.

Tests must be FDA authorized to be covered without cost sharing (copayment, coinsurance or deductible). FDA-authorized tests include tests approved for patient use through pre-market approval or emergency use pathways, and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval.

Members should work with their provider to order a test. Additional member guidance on testing can be found here.

Please do not collect upfront payment from the member. Benefits will be otherwise adjudicated in accordance with the member’s health plan. We will reimburse COVID-19 testing in accordance with applicable law, including the CARES Act and UnitedHealthcare’s reimbursement requirements. State variations and regulations may apply during this time. 

Date Reference Guide: Keep track of which temporary measures are expiring and which are being extended with our Summary of COVID-19 Dates by Program.

  • Rapid Point of Care Testing: UnitedHealthcare will cover FDA-authorized rapid point of care virus/antigen detection and antibody testing.

  • COVID-19 Testing-Related Visits: UnitedHealthcare is also waiving cost sharing for COVID-19 testing-related visits received in-person or via telehealth for the following health plans: 
    • Medicare Advantage
      Waiver of cost share is effective from Feb. 4, 2020 through the national public health emergency period, currently scheduled to end Jan. 20, 2021, for in-network and covered out-of-network testing-related visits.

    • Individual and Group Market health plans
      Waiver of cost share is effective from Feb. 4, 2020 through the national public health emergency period, currently scheduled to end Jan. 20, 2021, for in-network and out-of-network testing-related visits.

    • Medicaid
      Waiver of cost share is subject to state regulations.
       
  • COVID-19 Treatment: More information is available on the COVID-19 treatment page.

  • Telehealth Services: More information is available on the COVID-19 telehealth page.

*Licensure requirements vary by state. In some states, a pharmacist or other health care professional, such as a nurse practitioner, may have the appropriate licensure to order a test. Please refer to state-specific licensure requirements for appropriate guidance.

An antibody test may determine if a person has been exposed to COVID-19, while a COVID-19 diagnostic test determines if a person is currently infected. FDA authorized tests include tests approved for patient use through pre-market approval or emergency use pathways, and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval. According to the FDA, an antibody test should not be used to diagnose a current infection. Virus detection should be used to diagnose a current infection. UnitedHealthcare strongly supports the need for reliable testing and encourages health care providers to use reliable FDA-authorized tests.

Test Registration Requested

UnitedHealthcare is requesting all physicians and health care professionals who perform and bill for COVID-19 antibody tests to register the test(s) that will be used for our members. This includes both hospital-affiliated and freestanding laboratories, as well as physician practices with in-house laboratories. The registration takes just a few minutes to complete. You’ll need to complete it for each specific test you offer. (For example, if you have two different tests that are offered to physicians/patients, you’ll need to complete the registration twice.) If you change the test(s) you use in the coming months, you’ll need to complete the survey again.

Please complete the COVID-19 Antibody Test Registration as soon as possible. To complete the test registration, you’ll need:

  • The laboratory tax ID number (TIN)
  • The type of antibody test rendered

UnitedHealthcare will use the registration information to assist providers in choosing tests that are FDA authorized and to better understand the clinical reliability of the tests being used.

UnitedHealthcare is following the CDC guidelines, which recommend that a physician order the test. FDA-approved tests are sent to an approved laboratory that can properly test for the presence of COVID-19.

COVID-19 tests can be ordered through a public health facility, commercial laboratory (e.g., LabCorp and Quest Diagnostics) or hospital. The commercial laboratory testing through LabCorp and Quest Diagnostics became available March 11, 2020. Additional laboratories – including local hospital systems – are also beginning to test.

If a care provider determines their patient needs a COVID-19 test, but is not able to conduct the test themselves, care providers should work with their local and state health department or an affiliated hospital to determine where their patients can go in their community to get tested. Depending on the patient’s identification, acuity and location, they may get any one of the approved tests. Care providers are encouraged to call ahead and work with their patients to take proper isolation precautions when referring them for testing.

Care providers should follow the guidance from commercial laboratories to help ensure that they properly collect and ship the COVID-19 specimens. For more information, review the CDC’s guidelines for COVID-19 specimen collection. Or, visit  labcorp.com and/or questdiagnostics.com.

UnitedHealth Group released a study that shows self-administered tests are 90% effective and significantly reduce the risk of infection for care providers when collecting the tests. Currently, self-administered tests must be (unless using an FDA-authorized at-home collection kit):

  • Ordered by a physician or health care provider (MD, DO, PA or NP), so clinics can register the test and help ensure chain of custody for the results
  • Conducted in the physical presence of a health care professional to help ensure the collection is done the right way (e.g., the patient put the nasal swab far enough into their nose to collect an appropriate sample – can’t just touch the nose)
  • Coordinated through local and state health departments for laboratory testing or use COVID-19 virus detection testing labs authorized by the FDA under the emergency use authorization act

Resources

Care providers can connect to the latest Centers for Disease Control and Prevention (CDC) guidance for health professionals, as well as travel advisories from the U.S. State Department.

We’re listening.

We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.

We’ll be making daily updates to this site. Be sure to check back often for the latest information. 


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Disclaimer:

The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency.  Additional benefits or limitations may apply in some states and under some plans during this time.

We will adjudicate benefits in accordance with the member’s health plan.

Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.