News

COVID-19 UPDATE: Temporary Suspension of Polymerase Chain Reaction (PCR) Testing Payment Policy

Date: 03/26/20

Note: Please view UPDATED: COVID-19 UPDATE: Temporary Suspension of Polymerase Chain Reaction (PCR) Testing Payment Policy for an updated end date for this guidance.

In response to provider feedback related to Superior HealthPlan’s proposed Physician Office Lab Testing (POLT) payment policy, we are proceeding with an alternative option to ensure medically necessary lab services are delivered in the appropriate setting. Superior will implement a Polymerase Chain Reaction (PCR) Testing payment policy effective January 1, 2020. 

PCR Respiratory Viral Panels (RVP) detect the RNA/DNA of multiple types of respiratory viruses in a single test, often through nasal, nasopharyngeal or oropharyngeal swab. RVPs may be indicated if the results will guide clinical decision-making for an immunocompromised or otherwise high-risk member. RVPs may also be covered if a member is critically ill and is in a health-care setting that cares for critically ill patients. 

The PCR testing payment policy limits reimbursement of the PCR testing procedural codes (CPT 87631, 87632 and 87633) to inpatient hospital, observation and hospital emergency room place of service. Effective with policy implementation, RVPs are no longer reimbursable in an office setting.

This payment policy will be applicable to providers that serve Medicaid (STAR, STAR Kids, STAR Health and STAR+PLUS), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP), Allwell from Superior HealthPlan (Medicare Advantage - HMO and HMO SNP) and Ambetter from Superior HealthPlan (Health Insurance Marketplace) members.

For policy details, please review the Polymerase Chain Reaction (PCR) Testing Policy on Superior’s Clinical and Payment Policy webpage. 

For any questions, please reach out to your local Superior HealthPlan Account Manager.