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Home Specimen Collection for COVID-19 Testing for AmeriHealth Members (Updated April 14, 2020)
02.01.01d Home Health Care Services
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.
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..
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
Black Box Warnings and/or Contraindications
0551 Skilled Nursing – Visit Charge
Issued on - 04/14/2020
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