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Get reimbursed for COVID-19 testing and treatment of uninsured individuals.    
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YOU ARE HERE

Home > Coronavirus (COVID-19) Information > COVID-19 Claims Reimbursement to
Health Care Providers and Facilities for Testing, Treatment, and Vaccine
Administration for the Uninsured


COVID-19 CLAIMS REIMBURSEMENT TO HEALTH CARE PROVIDERS AND FACILITIES FOR
TESTING, TREATMENT, AND VACCINE ADMINISTRATION FOR THE UNINSURED

Catalog of Federal Domestic Assistance number (CFDA): 93.461




UPDATE: NEW INFORMATIONAL RESOURCES ARE AVAILABLE FOR PROVIDERS AND PATIENTS
INTERESTED IN LEARNING MORE ABOUT THE HRSA COVID-19 UNINSURED PROGRAM

 * Patient Fact Sheet: HRSA COVID-19 Uninsured Program Fact Sheet (English PDF -
   173 KB)
   * Spanish version (PDF - 162 KB)
 * Provider Fact Sheet: What Providers Need to Know About COVID-19 Vaccine Fees
   and Reimbursements (English PDF - 170 KB)
   * Spanish version (PDF - 230 KB)
 * April 13, 2021 Webcast: Getting Started with the HRSA COVID-19 Uninsured
   Program
   * View the webcast
   * Download the slides (PDF - 3.2 MB)


ABOUT THE PROGRAM

The U.S. Department of Health and Human Services (HHS), provides claims
reimbursement to health care providers generally at Medicare rates for testing
uninsured individuals for COVID-19, treating uninsured individuals with a
COVID-19 diagnosis, and administering COVID-19 vaccines to uninsured
individuals.

A separate program, the HRSA COVID-19 Coverage Assistance Fund, is available to
reimburse providers for COVID-19 vaccine administration to underinsured
individuals whose health plan either does not include COVID-19 vaccination as a
covered benefit or covers COVID-19 vaccine administration but with cost-sharing.

View Frequently Asked Questions.


HOW IT WORKS

Health care providers who have conducted COVID-19 testing or provided treatment
for uninsured individuals with a COVID-19 primary diagnosis on or after February
4, 2020 can request claims reimbursement through the program electronically and
will be reimbursed generally at Medicare rates, subject to available funding.
Providers can also request reimbursement for COVID-19 vaccine administration.
Steps will involve: enrolling as a provider participant, checking patient
eligibility, submitting patient information, submitting claims, and receiving
payment via direct deposit.

To participate, providers must attest to the following at registration:

 * You have checked for health care coverage eligibility and confirmed that the
   patient is uninsured. You have verified that the patient does not have
   coverage through an individual, or employer-sponsored plan, a federal
   healthcare program, or the Federal Employees Health Benefits Program at the
   time services were rendered, and no other payer will reimburse you for
   COVID-19 vaccination, testing and/or care for that patient.
 * You will accept defined program reimbursement as payment in full.
 * You agree not to balance bill the patient.
 * You agree to program terms and conditions and may be subject to
   post-reimbursement audit review.


FOR WHOM CAN CLAIMS BE SUBMITTED

Providers may submit claims for individuals in the U.S. without health care
coverage.


WHAT'S COVERED

Reimbursement under this program will be made for qualifying testing for
COVID-19, for treatment services with a primary COVID-19 diagnosis, and for
qualifying COVID-19 vaccine administration fees, as determined by HRSA (subject
to adjustment as may be necessary), which include the following:

 * Specimen collection, diagnostic and antibody testing.
 * Testing-related visits including in the following settings: office, urgent
   care or emergency room or telehealth.
 * Treatment: office visit (including telehealth), emergency room, inpatient,
   outpatient/observation, skilled nursing facility, long-term acute care
   (LTAC), rehabilitation care, home health, durable medical equipment (e.g.,
   oxygen, ventilator), emergency ambulance transportation, non-emergent patient
   transfers via ambulance, and FDA-licensed, authorized, or approved treatments
   as they become available for COVID-19 treatment.
 * Administration fees related to FDA-licensed or authorized vaccines.

Claims will be subject to Medicare timely filing requirements.

Services not covered by traditional Medicare will also not be covered under this
program. In addition, the following services are excluded:

 * Any treatment without a COVID-19 primary diagnosis, except for pregnancy when
   the COVID-19 code may be listed as secondary.
 * Hospice services.
 * Outpatient prescription drugs.

All claims submitted must be complete and final.


CLAIMS SUBMISSION

Information on claims submission can be found at:
coviduninsuredclaim.linkhealth.com .


CLAIMS REIMBURSEMENT

Claims for reimbursement will be priced as described below for eligible services
(see coverage details above).

 * Reimbursement will be based on current year Medicare fee schedule rates
   except where otherwise noted.
 * Reimbursement will be based on incurred date of service.
 * Publication of new codes and updates to existing codes is made in accordance
   with the Centers for Medicare and Medicaid Services (CMS).
 * For any new codes where a CMS published rate does not exist, claims will be
   held until CMS publishes corresponding reimbursement information.


WHEN CAN I LEARN MORE?

Please check back often for the latest updates and stay connected with us on
Twitter , Facebook , Instagram  and LinkedIn .

Date Last Reviewed:  June 2021





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