Thank you front liners

The New York State Governor’s Executive Order #202.24 temporarily modified Section 6801 of the NYS Education Law and Subdivision (6) of section 571 of the NYS Public Health Law to authorize licensed pharmacists to:

  • Order COVID-19 tests, approved by the Food and Drug Administration (FDA), to detect SARS-CoV-2 or its antibodies.

  • Administer COVID-19 tests, subject to CLIA Certificate of Waiver requirements and pursuant to the federal Clinical Laboratory Improvement Amendments of 1988, in patients suspected of a COVID-19 infection or those suspected of having recovered from COVID-19 infection, subject to completion of appropriate training developed by the Department of Health.

Pharmacies in the CDPHP network who wish to participate in specimen collection or testing should contact CVS Caremark at 1-866-488-4708 to enroll in the New York COVID-19 Testing Network.

The following are billing instructions for CDPHP: BIN: 004336, PCN: ADV, GRP: RXCDPHP

NCPDP D.0 Segment Field

Value

Product/Service ID (407-D7)

Specimen Collection
UPC: 6004-0417-80
NCPDP NDC: 99999-0992-11

Professional Service Codes

Specimen Collection
Submit “MA” in the Professional Service Code Field (400-E5) of the DUR/PPS Segment.

CLIA-waived Diagnostic Testing
Submit “PP” in the Reason for Service Code field (439-E4).
Submit “PT” in the Professional Service Code Field (440-E5).
Submit “00” in the Result of Service Code field (441-E6).

Quantity Dispensed (442-E7)

Enter a value of “1”.

Day Supply (405-D5)

Enter a value of “1”.

Prescriber ID (411-DB)

The NPI of the provider authorized to order the test should be submitted. This may be a pharmacist.

Provider ID (444-E9)

Enter the NPI of the authorized provider administering the test.

 

Reimbursement

Specimen collection
$0 cost for member
$0 ingredient cost
Pharmacy reimbursed an administration fee of $23.46

CLIA-waived Diagnostic Testing
$0 cost for member
$0 ingredient cost
Pharmacy reimbursed an administration fee of $51.31

 

Pharmacies that conduct COVID-19 testing and bill for it should not also bill for specimen collection. Reimbursement for the test includes specimen collection.