4/4/2022 - OTC COVID Tests for Medicare Patients
OTC Covid Tests for Medicare Patients
Effective immediately Medicare Part B will cover up to 8 at home COVID tests per month, per beneficiary. The reimbursement for these tests will be $12 each. You will need to get the patient's red, white, and blue card (MBI number) for billing. These will NOT be billed to the Medicare Advantage coverage. ALL Medicare Part Band Part C (Medicare Advantage) will be billed and paid through the Medicare Part B plan.
You can submit these claims to EBS using our BIN 610160 and the PCN for your Medicare - (State). This PCN can be found on the EBS website ebsservice.com under the header of NCPDP Billing Services. When looking for the appropriate Medicare PCN for these tests you will want to use the one that is labeled Medicare - (your state) (example Medicare-Missouri). This is the same plan you would have used to bill your vaccine administration.
Be sure to use the NDC for your test(s). You will want to use the actual number of tests (NOT the number of boxes) you are dispensing for your quantity.
Please submit your claims with the diagnosis code of
These tests have been added to our system for billing. If you have other NDC's that you will be using, please notify us by email at firstname.lastname@example.org and they will need to be added prior to transmitting your NCPDP claim(s).
Quickvue At-Home Covid-19 Test NDC # 14613033972 Qty 2
Inteliswab Covid-19 Rapid Test NDC # 8337000158 Qty 2
IHEALTH Covid-19 AG Rapid Test NDC # 56362000589 Qty 2
Flowflex Covid-19 AG Home Test NDC # 82607066027 Qty 2
Flowflex Covid-19 AG Home Test NDC # 82607066026 Qty 1
Ellume Covid-19 Home Test NDC # 56964000000 Qty 2
Carestart Covid-19 AG Home Test NDC # 50010022431 Qty 2
Binaxnow Covid-19 AG Self Test NDC # 11877001140 Qty 2
Pixel Covid-19 Home Collection Kit NDC # 42022224 Qty 1
Lucira Check-It Covid-19 Test NDC # 10055097004 Qty 1
Everlywell Covid-19 Home Collection Kit NDC # 51044000842 Qty 1
You will use diagnosis code of Z20.828
If the patient has received their maximum allotment of 8 tests per month, your claim could be denied. It is advised that providers have the patient's credit card or ACH information on file to collected any amounts due.