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MedicaidCoverageMedium impact

Billing Guidance to Pharmacies for COVID-19 Testing

Healthfirst·NY·Provider Update
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Healthfirst now allows pharmacies to bill for FDA-approved or EUA-authorized COVID-19 tests under Medicaid Managed Care and Personal Wellness Plans during the declared emergency. Pharmacies must use specific billing codes and submit claims through CVS Caremark with proper Professional Service Codes and incentive fee amounts.

Action Required

Action needed
Immediately: Pharmacies billing Healthfirst Medicaid Managed Care and Personal Wellness Plans must update billing procedures for COVID-19 testing. Use 'MA' in Professional Service Code field (440-E5) for specimen collection only, or 'PP' in Reason for Service Code field (439-E4), 'PT' in Professional Service Code field (440-E5), and '00' in Result of Service Code field (441-E6) for CLIA-waived testing. Include positive incentive fee amounts in field 438-E3. Independent pharmacies should contact CVS Caremark at 1-866-488-4708 for submission details.

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