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Medicare Coverage of Over-the-Counter COVID-19 Tests
Beginning 4/4/2022 and continuing through the end of the COVID-19 PHE, people with Medicare Part B, including those enrolled in a MA plan, are eligible to receive up to eight OTC tests per calendar month.
This benefit has been added as a demonstration by CMS. The goal of the demonstration is to find out if Medicare payment for OTC COVID-19 tests will improve access to testing and result in Medicare savings or other program improvements.
Medicare enrolled providers and suppliers, excluding DME suppliers, may participate in the demonstration.
Eligible institutional and noninstitutional providers and suppliers will bill for the tests on the standard claim format (837 Professional or Institutional) using HCPCS code K1034.
- HCPCS code K1034 applies to all OTC, FDA-approved, authorized, or cleared self-administered COVID-19 tests.
- Roster bills are not allowed for OTC tests.
- Claims cannot be sent to the MAC by the patient.
Medicare payment is $12.00 per OTC COVID-19 test. This is a flat payment rate and it is not geographically adjusted.
Please use the following resources to obtain further information on the OTC demonstration.
- COVID-19 Over-the-Counter Tests
- Fact Sheet: Medicare Covers Over-the-Counter COVID-19 Tests
- CMS Press Release: Biden-Harris Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests
- Medicare Coverage of Over-the-Counter COVID-19 Tests: Frequently Asked Questions