This article was revised on July 16, 2021, to update the coverage effective dates and simplify the format. To learn about treatment for COVID-19, please read this article.
To learn about testing for COVID-19, please read this article.
Billing and coding for COVID-19 tests
AmeriHealth New Jersey will cover COVID-19 testing as follows:
Diagnostic tests: Covered without member cost-sharing* (i.e., copayment, deductible, and coinsurance) when performed at any site, including a physician's office, urgent care center, hospital or hospital emergency room, pharmacy, or during a home health visit or drive-through testing center visit.
Antibody tests: Covered without member cost-sharing* when performed at a physician's office, urgent care center, hospital or hospital emergency room, pharmacy or during a home health visit or drive-through testing center visit, when ordered or authorized by a licensed or qualified health care professional.
Coverage for AmeriHealth New Jersey members for both in and out-of-network testing and diagnosis of COVID-19 is
effective March 6, 2020, through a period of 90 days after the end of the state of emergency.
AmeriHealth Pennsylvania will cover COVID-19 diagnostic tests and antibody tests with no member cost-sharing when directed by the member's health care provider. Testing coverage for AmeriHealth Pennsylvania members is
effective March 6, 2020, through
October 31, 2021, or the
duration of the public health emergency, whichever is later.
* The waiver of cost-sharing for both in and out-of-network testing and diagnosis of COVID-19 will continue until 90 days after the end of the state of emergency.
Please review the policy News Article,
Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)), for applicable codes. You can view the AmeriHealth New Jersey or AmeriHealth Pennsylvania articles in the
News & Announcements section of our our Medical and Claim Payment Policy Portal.
The list of applicable codes includes:
- diagnostic testing codes
- diagnostic antigen testing codes
- antibody testing codes
- specimen collection codes
- laboratory testing for differential diagnosis codes
- specimen collection for differential diagnosis laboratory testing codes
- ICD-10 diagnosis codes
AmeriHealth is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all AmeriHealth members and providers to visit our dedicated COVID-19 AmeriHealth New Jersey or
AmeriHealth Pennsylvania webpages regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.
Read more about coverage of services related to COVID-19 in the News Articles posted on our
Medical and Claim Payment Policy Portal.