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TRICARE Coverage for COVID-19 Testing

Friday, March 13, 2020
updated March 18, 2020

With the spread of the coronavirus disease (COVID-19) now across the U.S., testing for COVID-19 remains important. Please review the following questions and answers about COVID-19 testing reimbursement for your TRICARE patients.

Is COVID-19 testing covered under TRICARE?
TRICARE covers medically necessary and appropriate testing. Beneficiaries suspected to have COVID-19 should be tested following Centers for Disease Control and Prevention (CDC) guidelines. 

Is prior authorization required?
There are no authorization requirements specific to COVID-19 testing. You do not need an approval from HNFS for medically necessary testing.

Are there utilization limits for how often this test can be provided?
No. Care must be medically necessary and appropriate. 

What copayment or cost-share will my TRICARE patients have?
Find current cost information on our Copayment and Cost-Share page.

Are there specific billing codes?
The Centers for Medicare & Medicaid Services (CMS) recently developed two new Healthcare Common Procedure Coding system (HCPCS) codes for providers and laboratories to test patients – HCPCS U0001 and U0002 – for dates of service on or after Feb. 4, 2020. A new CPT® code, 87635, was released for immediate use effective Friday, March 13, 2020.

The CMS verbiage includes the term “panel.” Are there limitations for other testing on the same date of service? 
There are no limitations for other testing on the same date of service. 

Can I submit claims to HNFS now or is there a waiting period?
We can accept claims for COVID-19 testing; however, they will be held until April 1 to allow for system updates.

What is the reimbursement rate?
Reimbursement will be based on billed charges (less network provider discounts) until criteria is met to establish a state prevailing rate.

TRICARE beneficiaries who are unsure where or when to seek care may contact the Military Health System Nurse Advice line. For the latest CDC guidelines, visit www.cdc.gov/COVID19.

 

 

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