Skip to main content

Important Update: Additional Policy Changes as PHE Ends

As the COVID-19 public health emergency (PHE) ends on May 11, 2023, there are changes to our policies and procedures that may impact services for Horizon BCBSNJ, Horizon TotalCare (HMOD-SNP)and Braven Health members.

Reimbursement Rate Changes

At the beginning of the PHE, the Centers for Medicare & Medicaid Services(CMS) set the rates/allowances for COVID-related services and supplies, like vaccine administration and lab tests and services. These rates/allowances may no longer apply for claims submitted for services provided on and after May 12, 2023.

Horizon will use pre-PHE allowances for services/supplies that existed before the PHE and apply standard pricing methodologies and/or the Medicare fee schedule for allowances for new services/supplies created since the beginning of the PHE.

Antibody Testing

Based on the FDA and CDC guidance, COVID-19 antibody testing will not be covered except for patients being evaluated for Multisystem Inflammatory Syndrome. This is subject to change for Braven Health members depending on future guidance issued by CMS.

COVID-19 Diagnostic Testing

Providers and pharmacies can only be reimbursed for rapid antigen testing and for the administration/collection of the sample for PCR tests. All PCR tests must be sent to a lab for processing. COVID-19 PCR tests will not be covered when the test sample reading is processed in an office or a pharmacy.

See other benefit changes effective May 12, 2023.