MedicaidCoverageMedium impact
Oregon Health Plan coverage of COVID-19 antibody testing
Oregon Health Plan·OR · Pediatrics, Emergency Medicine, Infectious Disease·Plan
Effective date
Jun 8, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Plan now restricts COVID-19 antibody testing coverage to only hospitalized patients under 21 being evaluated for MIS-C, using FDA-approved tests. Two specific billing codes are available with set reimbursement rates.
Action Required
Immediately: Billing team must restrict COVID-19 antibody test billing to only hospitalized patients under 21 being evaluated for MIS-C. Use CPT codes 86328 ($45.23) or 86769 ($42.13) only when tests have FDA Emergency Use Authorization or approval. Update billing system to flag inappropriate use - other antibody testing will not be covered.