The following testing options, pricing, and logistics solutions provide guidance for employer groups wanting to test employees for Coronavirus (COVID-19) when returning to work.

Virus testing approach 1 – minimize insurance plan billing

Private insurance plans provided by employer organizations, and plans that employees might have elsewhere, are all required to pay for COVID-19 testing with no co-pay. This includes out-of-network doctor visits. The most common testing methods with billable codes are nasopharyngeal and oral swab sample collections, which are sent to labs for testing using existing CPT and ICD testing codes, according to CMS and AMA guidance. With proper billing, the total billed cost per employee for COVID-19 testing should be $102.66, where $51.33 is billed by the doctor, and $51.33 is billed by the lab. The total COVID-19 test cost per employee billed to the plan should be $102.66.

Unfortunately, what we are witnessing in the marketplace are the same overbilling practices we see all the time. Health systems and labs work together to bill full respiratory panels at $231, which includes the COVID-19 testing, plus additional unwanted testing when all that is desired by employers is the COVID-19 test for return to work. The medical justifiable reason being that patients might have the regular flu, bronchitis, or other viruses, so they must test for all. You may have even seen news clips of hospitals testing for both at their drive-through centers.