Up-to-date information and resources for our members can be found at:
If members receive COVID-19-related services, including testing, treatment or the vaccine, at an out-of-network provider, they may be responsible for the cost of the treatment, test, vaccine and/or administration based on their individual benefits.
When the federal vaccine supply runs out, vaccine providers may begin billing patients for any amount not covered by their health plan.
We encourage members to speak to their primary care provider, pharmacist, or refer to this NCDHHS website if they have questions about COVID-19 testing.
Individuals should seek medical attention immediately for symptoms such as trouble breathing, persistent pain or pressure in the chest, fainting, new confusion or inability to arouse, or bluish lips or face.
Effective May 12, 2023, COVID-19 tests administered by a provider that are consistent with CDC guidance and has been cleared, approved or given emergency use authorization (EUA) by the FDA are covered based on each individual’s insurance plan, and members may be responsible for a portion of their costs to include copayments, coinsurance and deductible amounts.
For more information on testing and how to find a COVID-19 test, visit NC Department of Health and Human Services.
COVID-19 tests do not need prior approval. That means your doctor doesn’t need to ask us for approval before you’re tested for COVID-19.
Effective May 12, 2023, members will be responsible for the cost of over the counter (OTC) COVID-19 tests and can pay or be reimbursed under health flexible spending arrangements (health FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs), or Archer medical savings accounts (Archer MSAs) because the cost to diagnose COVID-19 is an eligible medical expense for tax purposes.
Eligible Medicare Advantage members may use an OTC card to purchase OTC COVID-19 tests.
Medicaid will continue to cover the cost of all FDA-approved COVID-19 tests, including home tests, with no member cost-share for Healthy Blue members through September 30, 2024.
Commercial members can purchase over-the-counter (OTC) tests with their health flexible spending arrangements (health FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs), or Archer medical savings accounts (Archer MSAs).
Effective May 12, 2023, Blue Cross NC and ASO groups will cover both the cost of the vaccine and vaccine administration at 100% when members receive the COVID-19 vaccine at an in-network provider as part of our preventive care services.
If members receive the COVID-19 vaccine at an out-of-network provider, they may be responsible for the cost of the vaccine and/or vaccine administration based on their individual preventative care benefits.
The federal government has invested in a large supply of COVID-19 vaccines and will continue to cover the cost of the COVID-19 vaccine until that supply is exhausted.
COVID-19 vaccines given at pharmacies are covered for Blue Cross NC members, as part of our preventive care services, and reimbursement will be determined based on whether the provider is in-network or out-of-network.
For Blue Cross NC members living or traveling outside of North Carolina, the cost of the vaccine and administrative fees are covered as preventive services, and reimbursement will depend on whether the provider is in network or out-of-network.
Yes. Effective May 12, 2023, Blue Cross NC and ASO groups are required to cover both the cost of the vaccine and vaccine administration at 100% when members receive the COVID-19 vaccine at an in-network provider as part of our preventative care services.
The federal government has invested in a large supply of COVID-19 vaccines and will continue to cover the cost of the COVID-19 vaccine until that supply is exhausted. We anticipate more information about the transition, including estimated vaccine costs, to be released by summer 2023.
Anyone age six months and older is now eligible for the COVID-19 vaccine. Children and teens ages five to 17 years old can only receive the Pfizer booster, and parental consent is required.
Visit the North Carolina Department of Health and Human Services for the most up-to-date information about the COVID-19 vaccine and booster.
North Carolina residents can find a spot using the vaccine location tool provided by NCDHHS.
Federal Employee Plan (FEP) members should use FEP’s vaccine network to locate a participating retail pharmacy.
We encourage members to speak with their primary care provider about the COVID-19 vaccine and staying current on recommendations.
Individuals can also refer to the CDC’s website, which includes an easy-to-use tool to determine when they are due for a COVID-19 vaccine or booster.
Blue Cross NC and ASO groups will cover both the cost of the vaccine and vaccine administration at 100% when members receive the COVID-19 vaccine at an in-network provider as part of our preventive care services.
Yes. The CDC recommends that anyone over the age of six months should receive the vaccine, including those who are pregnant, plan to become pregnant or breastfeeding.
According to the CDC, the vaccine and boosters are safe to receive during your pregnancy. It is one of the best ways to protect yourself and your baby because pregnant women are at an increased risk for severe illness from COVID-19. The CDC further notes that for women who are breastfeeding, the vaccine is safe and can pass along COVID-19 antibodies to your breastfeeding child, providing them with further protection from the virus.
If you have additional questions about protecting your newborn from COVID-19, consult your pediatrician. Guidelines and recommendations are constantly changing, and they can ensure you're following the latest policies.
COVID-19 treatments are covered based on each individual’s insurance plan, and members may be responsible for a portion of their treatment costs to include copayments, coinsurance and deductible amounts.
Blue Cross NC Medicare Advantage members will continue to be covered under the Part B preventive vaccine benefit when receiving monoclonal antibodies until the end of the calendar year that the EUA declaration ends. Blue Cross NC Medicare Advantage members will be responsible for cost sharing when receiving treatment at an out-of-network facility, as specified under the plan benefit, beginning on June 10, 2023. COVID-19 treatment is covered with no cost-sharing for Healthy Blue members through September 30, 2024.
The CDC encourages everyone to contact a healthcare provider soon after testing positive to determine treatment eligibility, even if symptoms are mild.
Blue Cross NC is currently covering telehealth services for behavioral health, primary care and outpatient visits, which accounted for more than 97% of telehealth claims received during the last two years.
The policy applies to all Blue Cross NC fully insured and administrative services only (ASO) plans, including the State Health Plan. It does not apply to Blue Cross NC members receiving care from out-of-state providers. Members who do not have a commercial plan can find more information about their telehealth coverage below.
Virtual (or telehealth) visits can be used with your primary care doctors, specialists, and behavioral health providers. Or any licensed NC provider who can provide telehealth services. Call your doctor before going into the office to see if telehealth is available.
The American Medical Association (AMA) has provided this table (PDF) to link the COVID-19 vaccine product codes to their associated immunization administration codes, manufacturer name, vaccine name(s), 10 and 11-digit National Drug Code (NDC) Labeler Product ID, and interval between doses. These codes are also located in the Medicine section of the CPT code set.
For commercial members, COVID-19 vaccine administration rates will align with the Blue Cross NC updated fee schedule released on April 1, 2023.
For Medicare Advantage members, COVID-19 vaccine administration fees will continue to be paid under Part B and providers will continue to be reimbursed $41.25, the rate established by the Centers for Medicare and Medicaid Services (CMS).
Counseling is included in any vaccine administration, per code definition. Effective May 12, 2023, Blue Cross NC will not reimburse CPT code 99401 when billed separately to counsel commercial members on the benefits of receiving the COVID-19 vaccine.
CPT code 99401 is not specific to counseling for COVID vaccines because counseling is inclusive and already built into the administration (CPT code 90460), per the code descriptor.
If counseling is provided for COVID or any other vaccine, outside of a vaccine that was actually administered, we do consider that separate counseling reimbursable, but it must be appended with an appropriate modifier, such as 25 or 59, to indicate it is separate and distinct.
For more information, please review our Commercial Reimbursement Policy.
In addition to the vaccine administration fee, Blue Cross NC will continue to participate in the Centers for Medicare and Medicaid Services (CMS) incentive program where providers are eligible for an additional $36.85 payment per dose for the administration of the vaccine in home settings for Medicare members, encouraging more members to get vaccinated and more providers to participate in vaccination efforts.
Providers that administer the COVID-19 vaccine at home for commercial members are not eligible for this additional payment.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
© 2023 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.