Over-the-Counter COVID-19 Tests for Home Use

Effective Jan. 10, 2022, NC Medicaid-enrolled pharmacies may bill for FDA approved over-the-counter (OTC) COVID-19 tests dispensed for use by NC Medicaid beneficiaries in a home setting, with or without a prescription issued by an NC Medicaid-enrolled provider. NC Medicaid Direct beneficiary implementation date is Jan. 10, 2022. Refer to beneficiaries’ managed care plan for guidance on the specific plan’s implementation date.

NC Medicaid will cover one kit per claim per date of service, with a maximum of four test kits every 30 days. Covered test kits are listed below. Please note that some kits will include two tests.

Pharmacists must submit the enrolled pharmacy’s NPI number on the claim unless prescribed by a provider.

Pharmacies must follow the NCPDP standard and use the NDC found on the package. Pharmacies will be reimbursed at State Maximum Allowable Cost per kit, specific to the NDC. Copayment will not apply.

Test Name NDC # Tests in Kit Billing Unit SMAC
Quickvue At-Home Covid-19 Test 14613033972 2 2 $14.50/test; $29.00/ kit 
Inteliswab Covid-19 Rapid Test 8337000158 2 2 $14.50/test; $29.00/kit 
IHEALTH Covid-19 AG Rapid Test 56362000589 2 2 $10.50/test; $21.00/kit 
Flowflex Covid-19 AG Home Test 82607066027 2 2 $12.49/test; $24.98/kit 
Flowflex Covid-19 AG Home Test 82607066026 1 1 $14.99/test; $14.99/kit 
Ellume Covid-19 Home Test 56964000000 2 2 $18.77/test; $37.54/kit 
Carestart Covid-19 AG Home Test 50010022431 2 2 $16.23/test; $32.46/kit 
Binaxnow Covid-19 AG Self Test 11877001140 2 2 $13.83/test; $27.66/kit 
Pixel Covid-19 Home Collection Kit 42022224 1 1 129.99/test; $129.99/kit 
Lucira Check-It Covid-19 Test 10055097004 1 1 $80.00/test; $$80.00/kit 
Everlywell Covid-19 Home Collection Kit 51044000842 1 1 $114.00/test; $114.00/kit 

*Please note this information is shared from SPECIAL BULLETIN COVID-19 #210: NC Medicaid Omicron COVID-19 Surge.