Based on current COVID-19 trends, the Department of Health and Human Services has planned for the federal public health emergency (PHE) for COVID-19 to expire on May 11, 2023. In support of the PHE ending, Humana has been updating its COVID-19 policies accordingly, including those related to COVID-19 testing.
These FAQs summarize Humana’s standard coverage and reimbursement for COVID-19 testing. These FAQs are a guideline only and do not constitute medical advice, guarantee of payment, plan preauthorization, an explanation of benefits or a contract. They do not govern whether a procedure is covered under a specific member plan or policy, nor is it intended to address every claim situation. Claims may be affected by other factors, such as state and federal laws and regulations, provider contract terms and our professional judgment.
COVID-19 testing: Humana coverage
1. Will Humana cover COVID-19 testing?
Humana covers a wide range of COVID-19 tests, including at-home, over-the-counter (OTC) tests as well as tests performed in laboratories. Please read the following FAQs closely, as coverage may vary depending on specific plan and type of test.
2. What is Humana doing to comply with the federal at-home, OTC COVID-19 test kit requirements?
Humana is committed to complying with these requirements and covering the cost of at-home, OTC COVID-19 test kits for our members within the limitations outlined below.
Humana Medicare Advantage and Medicaid members:
Beginning April 4, 2022, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare beneficiaries with Part B coverage, including those enrolled in Medicare Advantage (MA), would be eligible for up to 8 OTC COVID-19 tests from participating pharmacies and providers each calendar month until the end of the COVID-19 public health emergency (PHE). Those with Part A-only coverage would not be eligible. Medicare will not cover costs for OTC COVID-19 tests obtained prior to April 4, 2022. This coverage is no longer in effect because the COVID-19 PHE ended on May 11, 2023.
Those with Medicaid coverage should contact their state Medicaid office for information regarding the specifics of coverage for at-home, OTC COVID-19 tests, as coverage rules may vary by state.
Humana commercial group members (those who receive insurance through their employer):
As announced by the U.S. Department of Health and Human Services, as of Jan. 15, 2022, all private insurance members were eligible to receive up to 8 at-home, OTC COVID-19 tests per 30 days (or calendar month) at no out-of-pocket cost until the end of the COVID-19 PHE. This coverage is no longer in effect because the COVID-19 PHE ended on May 11, 2023.
3. Is a referral, authorization or prescription required to obtain an at-home, OTC COVID-19 test?
Humana commercial group members:
At-home, OTC COVID-19 tests did not require a referral, authorization or prescription. Humana members were eligible to receive up to 8 at-home, OTC COVID-19 tests per 30 days (or calendar month) at no out-of-pocket cost during the COVID-19 PHE.
Humana Medicare Advantage and Medicaid members:
At-home, OTC COVID-19 tests did not require a referral, authorization or prescription. Humana MA members were eligible to receive up to 8 at-home, OTC COVID-19 tests per 30 days (or calendar month) at no out-of-pocket cost during the COVID-19 PHE.
Those with Medicaid coverage should contact their state Medicaid office for information regarding the specifics of coverage for at-home, OTC COVID-19 tests, as coverage rules may vary by state.
4. Does Humana still cover COVID-19 tests ordered by a physician or other licensed healthcare professional?
Humana commercial group members:
Humana commercial group members are eligible for COVID-19 testing for a
Covered COVID-19 testing and related services were available with no out-of-pocket costs during the COVID-19 PHE.
For covered COVID-19 testing provided after the COVID-19 PHE, please verify member plan benefits as any applicable member cost share would apply.
COVID-19 testing must be ordered by a physician or other licensed healthcare professional because the member:
- Has COVID-19 symptoms,
- Has been exposed to someone with suspected or confirmed COVID-19, or
- Requires pre-admission or pre-procedural testing in an asymptomatic individual.
Humana commercial group members may NOT be eligible for coverage of COVID-19 testing for any indications other than those listed above including, but not limited, to:
- Employment (e.g., pre-employment, return to work) or school purposes (e.g., return to school);
- Entertainment purposes (e.g., prior to a concert or sporting event);
- General population or public health screening;
- Physicals (executive or routine);
- Screening in a congregate setting;
- Sports participation; or
- Travel purposes.
Humana commercial group members are encouraged to check their plan documents for more details about their coverage.
Humana Medicare Advantage members:
During the COVID-19 PHE, there were no out-of-pocket costs for Humana Medicare Advantage and Medicaid members who received a
For covered COVID-19 testing provided after the COVID-19 PHE, please verify member plan benefits as any applicable member cost share would apply. In addition, standard ordering requirements apply to lab-performed COVID-19 tests.
Humana Medicaid members:
Medicaid plans will continue to follow state requirements for COVID-19 testing.
5. Do COVID-19 tests require referral?
During the COVID-19 PHE, referral requirements were waived for COVID-19 testing. After the end of the COVID-19 PHE, COVID-19 tests may be subject to any applicable referral requirements, based on member’s benefit plan.
COVID-19 testing: Billing
6. What procedure code is reported?
When selecting a procedure code that is available for the applicable date of service, a provider must use the most specific procedure code that describes the COVID-19 test performed. Only one procedure code should be billed for each service; do not report both an applicable HCPCS code and CPT code when only one COVID-19 test was provided.
7. What date of service is reported for a lab-performed test?
Report the date of service using the date the specimen was collected.