For guidance on test ordering, specimen collection and processing please consult your contracted lab, hospital or OHA for the state lab. Medicare and the AMA have released codes to use when testing for COVID-19, which can be found in the "Lab test" section of the Oregon Medicaid COVID-19 Provider Guide.
COVID-19 antibody testing
During the COVID-19 emergency, CareOregon will follow Oregon Health Plan (OHP) coverage guidance for COVID-19 antibody testing. COVID-19 antibody testing (also known as serology testing) to diagnose SARS-CoV-2 coverage criteria:
- Uses tests that have FDA Emergency Use Authorization (EUA) or FDA approval and
- Is to evaluate a hospitalized person under age 21 for possible multisystem inflammatory syndrome in children (MIS-C).
COVID-19 home tests available for members
Home tests for COVID-19 are now available for Medicaid members who have COVID-19 symptoms or may have been exposed to someone with COVID-19. Members may get up to eight tests every 30 days. Many brands of home tests are fully covered, but not all. See our formulary for details.
Members do not need a prescription for tests that do not require prior authorization. All tests must be dispensed by a pharmacy. The Oregon Board of Pharmacy allows pharmacists to prescribe COVID-19 home tests.
Members may be able to get reimbursement if they pay for tests out of pocket. Members should submit for reimbursement using this form. Receipts must be included.
For pharmacies: Processing home tests
- Pharmacies should submit claims for home tests to the Pharmacy Benefit Manager (PBM) through the pharmacy point of sale system.
- Home tests should not be billed through the medical benefit. Please do not submit these to QNXT.
- The prescribing provider on these claims should include a pharmacist that has a current Oregon Medicaid ID.