MedicaidCoverageHigh impact
COVID-19 Laboratory Testing Reimbursable as a Self-Referred Service
Maryland Medicaid·MD · Pathology, Infectious Disease·Provider Transmittal
Effective date
Feb 4, 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 to bill MCOs directly without prior authorization. Laboratories must be enrolled in the Maryland Medicaid Program to receive reimbursement under the specified fee-for-service rates for six COVID-19 testing codes.
Action Required
By July 27, 2020: Billing team must update claim processing rules to recognize COVID-19 laboratory codes (U0001, U0002, 87635, U0003, U0004, G2023, G2024) as self-referred services for Maryland Medicaid MCO enrollees—these codes no longer require prior authorization or network restrictions. Ensure billing system applies the specified FFS rates ($23.46–$100.00 depending on code). Verify that all non-network laboratories submitting COVID-19 tests are enrolled with Maryland Medicaid Program via eprep.health.maryland.gov before processing claims. For unresolved questions, contact Tenesha Lynch (laboratories) at tenesha.lynch@maryland.gov or Pam Williams (MCOs) at pam.williams@maryland.gov. Failure to update will result in claim denials or payment delays for COVID-19 laboratory services.