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Eliminating Cost Sharing Related to COVID-19 Testing and Evaluation

In compliance with NJ DOBI Bulletin No. 20-03, Horizon BCBSNJ is waiving member out-of-pocket costs for all charges associated with a visit to an in-network primary care physician or urgent care center or an in-network or out-of-network Emergency Room (ER) for COVID-19 testing for members presenting for care with concerns related to COVID-19 or reported exposure to an individual diagnosed with COVID-19.

Physicians and facilities are prohibited from billing any fully insured Horizon BCBSNJ member or State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) member for any services connected to COVID-19 evaluation or testing, performed in keeping with the Centers for Disease Control and Prevention (CDC) guidelines.

These changes take effect immediately for Horizon BCBSNJ’s fully insured members, including those covered through Medicaid, Medicare, Individual and Small Group policies, as well as members covered by the SHBP/SEHBP. Horizon BCBSNJ will continue to work with other self-insured customers that provide coverage for their employees on their specific plan designs.

Submitting claims
For cost-sharing obligations to be waived, claims must include a diagnosis of:

  • Z20.828 (Contact with and suspected exposure to other viral communicable diseases) or
  • Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out)

We believe these two ICD-10 codes are the most appropriate for reporting the situation where the purpose of the visit is to be tested for COVID-19. Other diagnoses in addition to these should also be reported as appropriate.

Claims that do not include one of the above diagnoses will be processed normally and payment will be reduced by any applicable member cost sharing based on the benefit plan.

Please visit the CDC website for additional information regarding diagnosis coding related to COVID-19.

Lab testing
Horizon BCBSNJ previously announced the waiving of cost sharing for the COVID-19 test. Claims from in-network and out-of-network labs for charges associated with the specific laboratory test for SARS-CoV-2, the virus causing COVID-19, for members with known exposure to an individual diagnosed with COVID-19 or with symptoms identified by the CDC as possible indicators of COVID-19 infection (fever, cough and shortness of breath) will not be subject to cost-sharing.

We will continue to work with our health care partners and provide the information you need.