Payment Information for Testing

Current Payment Methods


Self-payment involves the patient paying directly out-of-pocket for COVID-19 testing in place of private health insurance. Payments may include cash, card, or personal check. This method of payment may be used for those who are uninsured or choose to not use their health insurance. There are also a number of no-cost testing centers throughout the state that can be utilized. They can be found on the NCDHHS website here:


Insurance Reimbursement

Based on the FFCRA and the CARES Act, most group health plans and health insurers providing either group or individual coverage are required to cover COVID-19 testing services. They must cover testing services with no additional cost-sharing, prior authorization, or other medical management requirements. Reimbursement occurs at a negotiated rate or at the cash price of the service if there is no negotiated rate (link under this paragraph). The North Carolina State Health Plan provides full coverage for COVID-19 testing regardless of the site of service, including pharmacies. At the federal level, Medicare will reimburse CLIA waived pharmacies if they temporarily enroll as an independent clinical laboratory. Lastly, like other insurances there is no cost for Medicaid beneficiaries to receive testing. The most recent information on FFCRA updates can be found here:




The Families First Coronavirus Response Act (FFCRA), the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA), and the Coronavirus Aid, Relief and Economic Security (CARES) Act provide government relief funding for the uninsured and underinsured to obtain testing. Funding is dispersed through the Health Resources and Services Administration (HRSA). Funding is also available from NC Medicaid through the NC Medicaid Optional COVID-19 Testing program for uninsured individuals.



Who Covers Testing Provided by Pharmacists?

Medicare Part B will cover testing provided by pharmacists as part of a Medicare-enrolled independent clinical laboratory. Using this method, payment for testing goes to the pharmacy, however, the pharmacy must have a CLIA waiver. A pharmacist may also collect lab specimens under contract with a doctor or practitioner. In this case, payment for testing would go to the doctor that the pharmacist is working under. This method is typically for pharmacies without a CLIA waiver. Testing can be performed in parking lot testing sites and still be reimbursed. For up to date information on CMS coverage and reimbursement, see the CMS website and the below link to COVID-19 FAQs on Medicare Fee-for-Service billing.

Pharmacies that have provided COVID testing to patients that are uninsured are eligible to request reimbursement from the US Department of Health and Human Services. Reimbursement rates typically match Medicare reimbursement rates.

Most commercial health plans will cover COVID-19 testing at no cost to the patient based on requirements set forth by the FFCRA and CARES Act. These requirements were applicable beginning March 18, 2020 and will apply for the duration of the COVID-19 public health emergency.



Who Pays for Testing?

For patients that are insured and would like to use their insurance, their specific health plan should cover the cost of testing.

For patients that are insured, but choose to not use their insurance, they will pay out-of-pocket for testing. An example of patients choosing this method would be those who desire to use their FSA/HSA accounts. The price set for testing will be dependent on the pharmacy, however it is important to keep in mind that large chain pharmacies, health departments, and other entities may offer testing at no charge.

For patients that are uninsured, federal acts can be used to request funding for testing at no cost to the patient. Some of the stipulations for requesting HRSA reimbursement include that the pharmacy cannot balance bill the patient and no additional payers can reimburse the pharmacy for testing services. To apply for HRSA reimbursement, providers must enroll as a provider participant, check patient insurance eligibility, and then submit patient information and the claim. HRSA reimbursements will generally be the current Medicare reimbursement rate for COVID-19 testing. Through the FFCRA, North Carolina Medicaid will also reimburse the costs for COVID-19 testing through the NC Medicaid Optional Covid-19 (MCV) Testing program. North Carolina residents who are currently uninsured are eligible for this program. This program can be applied for here: Up to date information on the MCV program can be found here:



What to Document?

If claims for testing are submitted to a patient’s prescription benefit, the product identifier code of the testing kit and a service code must be used for billing purposes. Documentation for this billing method should be maintained in the same way that prescriptions are billed. It is recommended that pharmacies keep documentation for the health plans they have contracts with. Pharmacies should also keep records of what billing and service codes are used to request coverage and reimbursement.

Like any other service offered to patients, pharmacies should document how much patients pay for COVID-19 testing and any type of billing that was used for testing. Documentation of the CLIA waiver for your pharmacy should be maintained to appropriately bill health plans and perform on-site testing.


How to Bill?

At this time, pharmacies should reach out to commercial health plans they are contracted with in order to find out billing instructions. For resources and up to date information on billing Medicare, Medicaid, and private insurance, please see the following: There is also information included on billing for uninsured patients and on companies that will assist with medical billing.


How to Find Out How Much a Plan Will Cover?

For commercial insurance plans, it is recommended that pharmacies reach out to each plan to inquire about billing and reimbursement for COVID-19 testing. Pharmacies may also submit claims for testing to a patient’s prescription benefit. These claims will require a product identifier for the test and a professional service code. Health plans may have more guidance posted on their websites.

Information on Medicare reimbursement rates for high throughput technology, CDC-developed and non-CDC developed diagnostic, and serology tests can be found here:

Reimbursement for uninsured patients will be based on current year Medicare fee schedule rates. Reimbursement is subject to available funding when using the reimbursement portal. Services covered include specimen collection, both diagnostic and antibody testing, and vaccination performed on or after February 4, 2020. Outpatient prescription medications for the treatment of COVID-19 will not be covered under this program nor any service not traditionally covered by Medicare.



For information on Medicaid reimbursements, see the following:


Information From Top Health Plans


NC State Health Plan (includes retirees):

NC Medicaid:

United Healthcare: