COVID 19 OTC Tests for home use are covered for full Medicaid enrollees through Sept. 30, 2024.
Details for NC Medicaid coverage is available in the Dec. 28, 2022, Medicaid bulletin titled, Update: OTC COVID-19 Tests for Home Use Pharmacy POS Coverage. The updated list of covered tests is below. Effective dates are for NC Medicaid Direct claims.
Please refer to the beneficiary’s health plan for effective dates, as dates could be different.
| Test name | NDC | # Tests in Kit | Billing Unit | SMAC | Effective Date |
|---|---|---|---|---|---|
| Quickvue At-Home Covid-19 Test | 14613033972 | 2 | 2 | $14.50/test; $29.00/ kit | 1/10/2022 |
| Inteliswab Covid-19 Rapid Test | 08337000158 | 2 | 2 | $14.50/test; $29.00/kit | 1/10/2022 |
| IHEALTH Covid-19 AG Rapid Test | 56362000589 | 2 | 2 | $10.50/test; $21.00/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 *NDC obsolete date 2/3/2022 | 1 | 1 | $129.99/test; $129.99/kit | 1/10/2022 |
| Lucira Check-It Covid-19 Test | 10055097004 | 1 | 1 | $80.00/test; $80.00/kit | 1/10/2022 |
| Everlywell Covid-19 Home Collection Kit | 51044000842 | 1 | 1 | $114.00/test; $114.00/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 |
| Pixel COVID-19 Home Collection Kit | 50024-0924-00 | 1 | 1 | $129.99/test; $129.99/kit | 11/1/2022 |
| On/GO Covid 19 at home test | 60006-0191-66 | 2 | 2 | $12.50/test: $25.00/Kit | 5/1/2023 |
| On/Go COVID 19 at Home Test | 60007-0930-40 | 1 | 1 | $13.79/test; $13.79/kit | 5/1/2023 |
Contact
NCTracks Call Center: 800-688-6696