MedicaidCoverageHigh impact
Oregon Health Plan coverage of COVID-19 testing
Oregon Health Plan·OR·Plan
Effective date
Aug 14, 2020
We identified it
Aug 19, 2026
Summary
Oregon Health Plan now covers COVID-19 viral testing for all OHP members (symptomatic and asymptomatic) as a diagnostic service when ordered by a qualified provider, with medical necessity determined by provider clinical judgment. Antibody testing is covered only for hospitalized children under 21 being evaluated for multisystem inflammatory syndrome (MIS-C). All tests must have FDA Emergency Use Authorization or FDA approval.
Action Required
By August 14, 2020: Billing team and providers must immediately begin processing COVID-19 viral testing claims for Oregon Health Plan members without prior authorization requirements. Update billing system configurations to recognize COVID-19 testing as covered diagnostic service for both symptomatic and asymptomatic OHP members. Ensure encounter forms and clinical decision support reflect that provider clinical judgment determines medical necessity (no specific medical necessity criteria required). Restrict antibody testing coverage to hospitalized members under age 21 with MIS-C evaluation in billing system logic. Verify all COVID-19 tests billed have FDA Emergency Use Authorization or FDA approval status in test verification process. Train billing team and front-desk staff to direct all OHP fee-for-service questions to COVID.19@dhsoha.state.or.us and CCO coverage questions to the member's specific CCO. Reference the Oregon Medicaid COVID-19 Provider Guide for specific billing codes and instructions. Failure to implement these changes will result in claim denials for valid COVID-19 testing services.