Provider Information on COVID-19 Coverage

Updated May 12, 2023

The Biden Administration ended the COVID-19 public health emergency on May 11, 2023. Some COVID-19 coverage may have changed.

Due to the Office of Superintendent of Insurance’s cost share waiver rule, BCBSNM fully insured and certain Interagency Benefits Advisory Council (IBAC) plans will continue to cover  COVID-19 services without cost share as detailed below. Benefits for members of self-funded plans may vary. See our member site for more information.

The American Medical Association released six new Current Procedural Terminology (CPT®) codes for COVID-19 vaccines and their administration, effective Sept. 11, 2023. Learn more here.

Fully Insured and Certain IBAC Members

Tests and Testing-Related Visits: Until further notice, Food and Drug Administration (FDA) authorized COVID-19 tests to diagnose COVID-19 and testing-related visits are covered with no member cost share. No prior authorization is needed. Testing coverage includes tests for pneumonia and influenza with no member cost share.

Over-the-Counter (OTC) Tests: We cover OTC COVID-19 diagnostic tests without cost share at in network pharmacies for up to eight tests per covered member every 30 days.

This program is through BCBSNM and Prime TherapeuticsTM pharmacy benefits. If a member does not have benefits through Prime Therapeutics, they should contact their pharmacy benefit administrator. More information is on our member site.

COVID-19 Treatment: The cost-share waiver that began on March 12, 2020, remains in effect. Follow our COVID-19 Coverage for Members web page for updates.

Telemedicine coverage is available, according to the member’s regular benefit level. Covered telemedicine services that are COVID-19 related testing or treatment will be covered without cost share. Check our telemedicine pagefor more details. 

Check Member Eligibility and Benefits

Benefits for members of self-funded plans may vary. Use the Availity® Essentials  or your preferred vendor for eligibility and benefit verifications.

Medicare Members

All services are covered according to the member’s current plan rules. See our Medicare Alerts and Announcements for more information.

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