Billing Question for Washington State Colleagues – FLU A/B and COVID Antigen Testing

Our billing department has informed us of a significant change in reimbursement policy from the Washington State Health Care Authority (HCA). Effective April 1, 2025, combo antigen tests for flu and COVID-19 (such as the Quidel Sofia 2 Flu + SARS Antigen FIA) are no longer reimbursed under Apple Health (Medicaid). Instead, providers must collect two separate swabs and run two individual tests, one for Flu A/B and one for COVID-19. 

According to our billing department these changes align with updated medical necessity criteria and fee-for-service billing instructions released by HCA. The combo kits are now considered non-reimbursable under Washington Medicaid guidelines. 

We currently use the Quidel Sofia system, which supports both combo and individual antigen tests. However, due to this reimbursement shift, we are being asked to transition away from the combo kits entirely in our outpatient point-of-care (POC) clinics. This is causing some space limitation issues for many of our outpatient clinics where space is challenging. 

Questions:

We’d appreciate hearing how others are navigating this change, especially in outpatient or urgent care settings where rapid testing is critical.