Home Specimen Collection for COVID-19 Testing for AmeriHealth Members (Updated April 14, 2020)




    Policy Impacted

    02.01.01d Home Health Care Services



    Purpose

    The purpose of this News Article is to provide advance notice regarding coverage for a home specimen collection for COVID-19 testing in response to the COVID-19 outbreak.

    This News Article addressing home specimen collection for COVID-19 testing is effective from March 6, 2020 through September 04, 2020 and is subject to re-evaluation for the duration of the public health emergency.



    Background

    There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has now been detected internationally. The virus has been named “SARS-CoV-2” and the disease it causes has been named “Coronavirus Disease 2019” (COVID-19). The SARS-CoV-2 virus has demonstrated the capability to rapidly spread, leading to significant impacts on healthcare systems and causing societal disruption. The potential public health threat posed by COVID-19 is high globally. To effectively respond to the COVID-19 outbreak, rapid detection of cases and contacts, appropriate clinical management and infection control, and implementation of community mitigation efforts are critical.

    To help reduce potential exposure of COVID-19, the Company is waiving the requirement that a member be homebound for the purpose of laboratory specimen collection for COVID-19 testing in their home..



    Indications

    N/A



    Coverage Statement

    In response to the COVID-19 outbreak, home specimen collection for COVID-19 testing is considered medically necessary and, therefore, covered when all of the following criteria are met:
    • The specimen is collected by a nurse from a home health agency or by a trained laboratory technician
      • The requirement that a member must be homebound (as defined in the medical policy) is waived, in order to receive a nurse visit from a home health agency for the purpose of laboratory specimen collection for COVID-19 testing in their home.
    • The specimen collection is medically necessary for the individual's condition and has been ordered by an eligible professional provider.
    • The specimen will be delivered to the appropriate Company participating laboratory to perform the test and send the results to the prescribing professional provider.



    Dosing and Administration

    N/A



    Black Box Warnings and/or Contraindications

    N/A



    Coding


    Revenue Codes

    0551 Skilled Nursing – Visit Charge


    CPT Codes

    G2023, G2024





    Issued on - 04/14/2020