ADVISORY
No. 240 February 8, 2022
COVID-19 Home Test Kit Coverage
Testing is vitally important to help reduce the spread of Coronavirus-2019 (COVID-19) and
to diagnose COVID-19 quickly so that it can be effectively treated. Over-the-Counter
(OTC) diagnostic SARS-CoV-2 antigen tests for home use are convenient, efficient, and
accurate in rapidly detecting the presence of certain proteins on the surface of the virus
that causes COVID-19.
This Advisory applies to Participants enrolled in the Maryland Fee-for-Service (FFS)
program and Participants enrolled in Managed Care Organizations (MCOs) that participate
in the Maryland HealthChoice Program.
Effective February 17, 2022, Maryland Medicaid Fee-For-Service (FFS) will expand
access to Food and Drug Administration (FDA) Emergency Use Authorized (EUA) and/or
FDA approved OTC COVID at-home tests for Maryland Medicaid Participants.
Maryland Medicaid will cover a maximum of four tests every rolling 30 days. Tests may be
selected from the list in Table 2 and mixed and matched between kits for a total of four
tests. Coverage of additional test kits exceeding the quantity limit described above will
require prior authorization. Participant copayment will not apply.
The ninth amendment to the COVID 19 PREP Act Declaration provides liability immunity
to licensed pharmacists and expands the scope of authority for them to order and
administer select COVID 19 therapeutics to populations authorized by the FDA. If the
participant does not have an order from a prescriber, prior to ordering an OTC COVID-19
at-home test, the pharmacist shall gather and document the following information and
retain it in the record just as any other prescription:
2
a. Participant’s Name and Date of Birth,
b. Participant’s Medicaid Identification number,
c. Reason for a test (such as COVID-like symptoms, COVID exposure), and
d. Date of symptom onset or date of known COVID-19 exposure, as appropriate
Pharmacies shall utilize the following billing instructions (Table 1) when submitting claims
for the test kits.
Table 1 - FFS Pharmacy NCPDP Billing
1
for OTC COVID-19 At-Home Test Kits:
NCPDP D.0. Claim Segment
Field
Value
436-E1 (Product/Service ID
Qualifier)
Enter a value of "03" (NDC)
407-D7 (Product/Service ID)
Enter one applicable NDC from Table 2
411-DB (Prescriber ID)
Enter Prescriber National Provider Identifier (NPI)
number
During a the federal Public Health Emergency, the
Service Provider ID (2Ø1-B1) may be submitted as for
qualifying COVID 19 related products
Table 2 - OTC COVID-19 At-Home Covered Tests
2
and Reimbursement
NDC
Drug Name
Test Count
(Package
Count)
Billin
g
Unit
11877001
133
BINAXNOW COVID AG CARD
HOME TEST
1
1
11877001
129
BINAXNOW COVID-19 AG
CARD
1
1
56964000
000
ELLUME COVID-19 HOME
TEST
1
1
1
More details on the COVID-19 OTC diagnostic SARS-CoV-2 antigen tests for home payer sheet is available under Payer Specific Information at:
https://www.mdrxprograms.com/ooep.html#PI
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As more products become available, this guidance will be updated.
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PDF (Professional Dispensing Fee as defined in COMAR 10.09.03.07)
In an effort to give timely notice to the pharmacy community concerning important pharmacy topics, the Maryland Department of Health (MDH)
Office of Pharmacy Services (OPS) has developed the Maryland Medicaid Pharmacy Program Advisory.
To expedite information timely to the pharmacy and prescriber communities, an email network has been established which incorporates the email
lists of the Maryland Pharmacists Association, EPIC, CARE, Long Term Care Consultants, headquarters of all chain drugstores and prescriber
associations and organizations.
It is our hope that the information is disseminated to all interested parties. If you have not received this email through any of the previously noted
parties or via MDH, please contact the OPS representative at 410-767-1455.
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82607066
026
FLOWFLEX COVID-19 AG
HOME TEST
1
1
14613033
937
QUICKVUE SARS ANTIGEN
TEST
1
1
14613033
908
SOFIA SARS ANTIGEN FIA
TEST
1
1
11877001
140
BINAXNOW COVID-19 AG SELF
TEST
2
2
50010022
431
CARESTART COVID-19 AG
HOME TEST
2
2
82607066
027
FLOWFLEX COVID-19 AG
HOME TEST
2
2
56362000
589
IHEALTH COVID-19 AG RAPID
TEST
2
2
08337000
158
INTELISWAB COVID-19 RAPID
TEST
2
2
14613033
972
QUICKVUE AT-HOME COVID-
19 TEST
2
2