Reminder for NC Medicaid-enrolled pharmacy providers: Point-of-sale (POS) billing for FDA-authorized over-the-counter (OTC) COVID-19 tests dispensed for use by NC Medicaid beneficiaries in a home setting remains in effect for NC Medicaid Direct and all five managed care plans.
Coverage of one kit per claim per date of service is allowed up to a maximum of eight tests every rolling 30 days. The eight total tests could be mixed and matched between one-test kit or two-test kits to get a total of eight tests.
Because a State Standing Order is issued for the OTC COVID-19 test for home use, dispensing may be under State Health Director and Chief Medical Office Dr. Elizabeth Cuervo Tilson’s National Provider Identifier (NPI), with or without a prescription issued by an active NC Medicaid enrolled provider. Alternatively, the claim may be submitted using the pharmacy’s NPI or the prescriber’s NPI if 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 does not apply.
Covered test kits with the SMAC are listed below. Effective dates are for NC Medicaid Direct claims. Please refer to the beneficiary’s health plan for effective dates, as date could be different.
| Test Name | NDC | #Tests in Kit | Billing Unit | SMAC | Effective Date (NC Medicaid Direct) |
|---|---|---|---|---|---|
| Quickvue At-Home COVID-19 Test | 14613033972 | 2 | 2 | $14.50/test; $29/ kit | 1/10/2022 |
| Inteliswab COVID-19 Rapid Test | 08337000158 | 2 | 2 | $14.50/test; $29/ kit | 1/10/2022 |
| IHEALTH COVID-19 AG Rapid Test | 56362000589 | 2 | 2 | $10.50/test; $21/kit | 1/10/2022 |
| Flowflex COVID-19 AG Home Test | 82607066027 | 2 | 2 | $12.49/test; $24.98/kit | 1/10/2022 |
| Flowflex COVID-19 AG Home Test | 82607066026 | 1 | 1 | $14.99/test; $14.99/kit | 1/10/2022 |
| Ellume COVID-19 Home Test | 56964000000 | 2 | 2 | $18.77/test; $37.54/kit | 1/10/2022 |
| Carestart COVID-19 AG Home Test | 50010022431 | 2 | 2 | $16.23/test; $32.46/kit | 1/10/2022 |
| Binaxnow COVID-19 AG Self-Test | 11877001140 | 2 | 2 | $13.83/test; $27.66/kit | 1/10/2022 |
| Pixel COVID-19 Home Collection Kit | 00042022224 | 1 | 1 | $129.99/test; $129.99/kit | 1/10/2022 |
| Lucira Check-It COVID-19 Test | 10055097004 | 1 | 1 | $80/test; $80/kit | 1/10/2022 |
| Everlywell COVID-19 Home Collection Kit | 51044000842 | 1 | 1 | $114/test; $114/kit | 1/10/2022 |
| Genabio COVID 19 Rapid at Home Test | 96852095300 | 2 | 2 | $12.99/test; $25.98/Kit | 12/15/2022 |
| Genabio COVID 19 Rapid at Home Test | 96852025431 | 1 | 1 | $12.99/test; $12.99/Kit | 12/15/2022 |
Contact
NCTracks Call Center at 800-688-6696