Updated Oct. 18, 2023
The Biden Administration ended the COVID-19 public health emergency on May 11, 2023. Some COVID-19 coverage has changed with the end of the public health emergency. Members’ standard benefits apply to testing and treatment of COVID-19. Benefits for members of self-funded plans may vary. See our member site for more information.
Lab tests to diagnose COVID-19 are covered at the member’s regular benefit level at both in-network and out-of-network providers. Benefits for members of self-funded plans may vary. Check eligibility and benefits for details on each member’s benefit.
Over-the-counter COVID-19 diagnostic tests are not covered. Benefits for members of self-funded plans may vary. Check eligibility and benefits for details on each member’s benefits.
Testing-related visits are covered at the member’s regular benefit level.
COVID-19 vaccines that are FDA-authorized are covered at the member’s preventive benefit level. Some groups may not cover preventive services, including COVID-19 vaccines. Check eligibility and benefits for details for each member. The American Medical Association released six new Current Procedural Terminology (CPT®) codes for Pfizer’s and Moderna’s vaccines and their administration, effective Sept. 11, 2023. Learn more here.
COVID-19 treatment with FDA-authorized oral anti-viral prescription medicines may be covered under our members’ pharmacy benefits. Members’ cost share will vary according to their benefit plan.
Medicare members: All services are covered according to the member’s current plan rules. See our Medicare Alerts and Announcements for more information.
Telemedicine and Telehealth coverage is available, according to the member’s regular benefit level.
Check Member Eligibility and Benefits
As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSTX’s provider website.
Please note checking eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member's ID card.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by third party vendors.