MedicaidPrior AuthMedium impact
Fee-for-service coverage of COVID-19 home testing policy update
Oregon Health Plan·OR · Family Medicine, Internal Medicine, General Practice +1 more·Provider
Effective date
Dec 1, 2021
We identified it
Jun 20, 2026
Summary
Effective December 1, 2021, Oregon Health Authority eliminated the requirement for primary care provider orders and prior authorization for up to 4 COVID-19 home test kits per month that use internet/smartphone interpretation. Additional tests beyond 4 per month still require PCP orders and prior authorization.
Action Required
Immediately: Billing team must update systems to bill OHA directly for fee-for-service COVID-19 home test dispensing to Oregon Health Plan members (up to 4 tests per month without prior auth). Bill appropriate CCO for CCO members. Pharmacies may use pharmacy NPI or enrolled pharmacist NPI as prescribing provider in NCPDP field 111-AM. Ensure prior authorization processes remain in place for requests exceeding 4 tests per month.