SPECIAL BULLETIN COVID-19 #219: Over-the-Counter Tests for Home Use

Pharmacies can bill for FDA-approved in-home tests

This bulletin is an update to COVID-19 Bulletins #210 and #215.

Effective Jan. 10, 2022, NC Medicaid-enrolled pharmacy providers may bill point-of-sale (POS) for FDA-approved over-the-counter (OTC) COVID-19 tests dispensed for use by NC Medicaid beneficiaries in a home setting. The test can be dispensed with or without a prescription issued by an active NC Medicaid enrolled provider. The implementation date for POS claims submission is Jan. 10, 2022, for NC Medicaid Direct. Refer to the managed care plan of the beneficiary for implementation date guidance.

NC Medicaid will cover one kit per claim per date of service. A maximum of eight tests is allowed every rolling 30 days. The eight total tests could be mixed and matched between one-test kits or two-test kits to get a total of eight tests.

A State Standing Order has been issued for the OTC COVID-19 test for home use.

Another option is to submit the claim using the pharmacy National Provider Identifier (NPI) unless the test is prescribed by a Medicaid-enrolled provider.

Pharmacies must follow the National Council for Prescription Drug Programs (NCPDP) standard and use the National Drug Code (NDC) found on the package. Reimbursement is at an NDC-specific State Maximum Allowable Cost (SMAC). Copayment will not apply.

Covered test kits with the SMAC are listed below.

CONTACT

NC Medicaid Contact Center: 888-245-0179