MedicaidCoverageHigh impact
COVID-19 Laboratory Testing Reimbursable as a Self-Referred Service
Maryland Medicaid·MD · Pathology, Infectious Disease, Emergency Medicine·Provider Transmittal
Effective date
Jun 25, 2020
We identified it
Jun 20, 2026
Summary
Maryland Medicaid now reimburses COVID-19 laboratory testing as a self-referred service, allowing non-network laboratories and providers to bill directly without prior authorization. Eleven reimbursable COVID-19 test codes have been added with effective dates ranging from February 2020 through June 25, 2020, with specific FFS rates for each code. Laboratories must be enrolled in the Maryland Medicaid program to receive reimbursement.
Action Required
By August 21, 2020 (policy issuance): 1) Billing team must immediately update billing system to recognize and process all 10 COVID-19 laboratory codes (U0001, U0002, G2023, G2024, 87635, U0003, U0004, 87426, 0223U, 0224U) with their corresponding Maryland Medicaid FFS rates. 2) Update fee schedules in billing software to reflect rates ranging from $23.46 to $416.78 per code. 3) Configure billing rules to allow COVID-19 tests to bypass prior authorization requirements as self-referred services for HealthChoice MCO members. 4) If your laboratory is not currently enrolled in Maryland Medicaid, submit enrollment application via eprep.health.maryland.gov immediately and email mdh.providerenrollment@maryland.gov with subject line 'Expedited COVID-19 ePREP Enrollment [Your Organization Name]' to request expedited approval backdated to state of emergency start date. 5) Ensure front desk and clinical staff are trained that COVID-19 testing does not require member pre-authorization for HealthChoice plans. Failure to enroll in Medicaid or properly configure billing codes will result in claim denials for COVID-19 testing services.