Medicare Coverage of Over-the-Counter COVID-19 Tests

The OTC COVID-19 test demonstration ended on 5/11/2023. Starting on 5/12/2023, Medicare no longer covers or pays for OTC COVID-19 tests for those with Medicare Part B benefits.

Beginning 4/4/2022 and continuing through 5/11/2023, people with Medicare Part B, including those enrolled in a MA plan, were eligible to receive up to eight OTC tests per calendar month.

This benefit was added as a demonstration by CMS. The goal of the demonstration was to find out if Medicare payment for OTC COVID-19 tests would improve access to testing and result in Medicare savings or other program improvements.

Medicare enrolled providers and suppliers, excluding DME suppliers, participated in the demonstration.

Eligible institutional and noninstitutional providers and suppliers could 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 were not allowed for OTC tests.
Claims could not be sent to the MAC by the patient.

Medicare payment was $12.00 per OTC COVID-19 test. This flat payment rate was not geographically adjusted.

Please use the following resources to obtain further information on the OTC demonstration.

Revised 10/14/2024