​​​COVID-19 tests for public health screening and surveillance are not covered

March 1, 2023

​As was previously communicated in our policy news article, Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)), AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, and AmeriHealth Administrators do not cover COVID-19 testing when the primary purpose of this testing is for public health screening and/or surveillance. This includes tests using pooling methodologies or any others with a current U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA).

As stated in Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)):

  • Scree​ning tests for SARS-CoV-2 are intended to identify occurrence of COVID-19 at the individual level even if there is no reason to suspect infection or COVID-19 exposure. The Centers for Disease Control and Prevention (CDC) includes examples of screening such as:
    • Testing employees in a workplace setting
    • Testing students, faculty, and staff in a school or university setting
    • Testing a person before or after travel
    • Testing at home for someone who does not have symptoms associated with COVID-19 and no known exposures to someone with COVID-19
  • Public health surveillance for SARS-CoV-2 includes ongoing systematic activities, including collection, analysis, and interpretation of health-related data that are essential to planning, implementing, and evaluating public health practice. An example of surveillance testing is a plan developed by a state public health department to randomly select and sample a percentage of all individuals in a city on a rolling basis to assess local infection rates and trends.

For example, the following ICD-10 screening codes, not an all-inclusive list, are not covered for COVID-19 testing:

  • Z11.59: Encounter for screening for other viral diseases
  • Z11.52: Encounter for screening for COVID-19
  • Z11.8: Encounter for screening for other infectious and parasitic diseases
  • Z11.9: Encounter for screening for infectious and parasitic diseases, unspecified
  • Z13.9: Encounter for screening, unspecified

For additional information on COVID-19 diagnostic, screening, and public health surveillance testing, please review the policy news article, Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)), which can be found in the News and Announcements section of the Medical and Claim Payment Policy Portal: