LH BULLETIN NO. 2020-03
TO: All Life & Health Insurers and HMOs Licensed in Oklahoma
FROM: Glen Mulready, Insurance Commissioner
DATE: May 22, 2020
SUBJECT: Antibody Testing (COVID-19)
The Governor of the State of Oklahoma has issued a Declaration of Emergency. That Executive Order 2020-07 was issued March 15, 2020. Further, a new Executive Order 2020-13 was issued on April 8, 2020.
All health carriers, other insurance industry representatives and other interested parties are encouraged to review the latest Oklahoma information about COVID-19 released by the Oklahoma Department of Health. (https://coronavirus.health.ok.gov/).
The Oklahoma Insurance Department (Department) is issuing this bulletin to assist individuals and entities regulated by the Department in effectuating the provisions of insurance-related services during this urgent public health challenge.
The Department has been working diligently over the past month with our state congressional delegation and federal officials to obtain Medicare pricing and additional guidance on Antigen and Antibody (Serology) testing. On May 19, the Centers for Medicare and Medicaid Services (CMS) issued Medicare Administrative Contractor (MAC) pricing details for the previously created CPT codes (86769, 86328) from the American Medical Association. CMS has yet to establish further guidance on these tests. In the absence of additional information, Carriers should follow the provisions of this bulletin.
COVID-19 PCR, Antigen and Antibody Testing
Currently, the Department is aware of three types of COVID-19 tests.
- PCR (Polymerase Chain Reaction) tests look for the presence of the unique DNA of COVID-19 in a patient
- Antigen tests look for a unique part of COVID-19, such as a specific protein on one of the unique COVID-19 spikes.
- Antibody tests (also known as serology tests) look for presence of antibodies in a patient’s immune system that may fight off the COVID-19.
Please be aware that the Department expects Carriers to cover PCR and antigen tests designed to detect the presence of COVID-19 when a patient’s symptoms indicate the medical need to conduct a test.
Regarding antibody tests, the Department expects Carriers to cover FDA-authorized antibody tests. Carriers shall waive cost-sharing for antibody testing and process claims in compliance with federal guidelines (e.g. the CARES Act). This includes tests approved for patient use through premarket approval or emergency use pathways, and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval. The Department expects Carriers to cover these antibody tests, but only when such tests are medically necessary and ordered by an appropriate treating medical professional who is tracking the symptoms, diagnosis, and prognosis of the patient in order to support diagnosis or treatment for COVID-19 or for treatment of another disease when information about COVID-19 antibodies may impact the future outcome of that treatment for a particular person. It is not considered medically necessary if a COVID-19 antibody test is to be used as part of “return-to-work” programs, public health surveillance testing or any efforts not associated with disease diagnosis or treatment.
Administrators – Self Funded Plans
Due to the public health crisis caused by COVID-19, the Department expects administrators for employer-sponsored self-funded health benefit plans to encourage plan sponsors to take steps that are consistent with this Bulletin. Plan sponsors should be made aware of the public health risks to all Oklahoma residents, and administrators should do all they can to encourage plan sponsors to take steps to remove barriers to accessing medically necessary testing, diagnosis, counseling, and treatment of COVID-19.
Questions or comments applicable to this bulletin should be directed to Mike Rhoads (firstname.lastname@example.org) or Ron Kreiter (email@example.com), Oklahoma Insurance Department, 400 NE 50th Street, Oklahoma City, OK 73105-1816.