Point of Care Test and Treat Workflows

Overview

The Point of Care Testing and Treatment (POCT) workflows support pharmacists in delivering test-and-treat services under state-authorized clinical protocols. These workflows guide the pharmacist through patient assessment, testing, clinical decision-making, treatment or prophylaxis, follow-up, and optional medical billing, all within a single, structured encounter.

What These Workflows Are Used For

The POCT workflows can be used for:

Clinical documentation of test-and-treat services
Point-of-care diagnostic testing, such as COVID-19, Influenza, and Strep
Treatment or prophylaxis prescribing, when permitted by state protocol
Follow-up patient encounters to assess outcomes or adherence
Medical billing, when the patient is eligible and billing criteria are met

Encounters may also be completed as documentation-only or self-pay, depending on patient needs, insurance coverage, and pharmacy policies.

Getting Started

Choose a patient

Log into Outcomes, then navigate to the patient profile using one of the following methods:

Search for an existing patient in the Outcomes global header.

If the patient is new to your pharmacy, add the patient to your center by clicking the add patient icon in the global header.

Add the patient's medical insurance

Once you have selected the patient and you wish to submit the encounter as a medical bill, select the 3 dots to the right of patient's name and select Edit Insurance
Select Add insurance for patient and input the required fields for the patient's medical insurance. Please ensure the patient has medical insurance added to their profile and that the information is input exactly how it appears on the patient's medical insurance card. Once complete, select save changes.

If you are not wanting to submit the encounter as a medical claim, you are not required to enter the patient's medical insurance.

Document an encounter

Navigate to the Start a Service section of the patient page using the patient page navigation ribbon on the left side of the patient page.
On the Start a Service section, select the appropriate encounter for your state from the list of available clinical protocol templates: COVID Test and Treat - Initial, Influenza Test and Treat - Initial, or Strep Test and Treat - Initial.

After selecting the workflow to initiate, clicking the "Check eligibility and coverage details" provides a real time eligibility and benefit check for the patient's medical insurance for associated health benefit service type code.

Encounter Details

Select the date of the encounter.
Select Next.

Enter any relevant Encounter Notes on the right side of the screen. These Encounter Notes follow the clinical encounter with the patient and are internal only to the pharmacist.

If your Testing Machine requires a patient identifier to be manually entered, enter the patient's phone number. This is a searchable field in Outcomes.

Eligibility

Answer the eligibility questions that are built to the clinical protocol authorized in your state.
Document additional treatments the patient has tried (optional).
Select Next.

The workflow is designed to provide clinical decision support so if a patient is deemed ineligible based on the clinical protocol authorized in your state, then you when advance to the next screen you will see Patient Ineligible with the affiliated contraindication(s).

Assessment

Under Vitals, input the appropriate vitals for the encounter.
Under Allergies & Side Effects, indicate if the patient has any reported medication allergies and document them.
Under Attestation, review the patient's reported medications, conditions, add relevant social and medical history.
Select Next.

At any given time during the encounter, you can select Save for Later if you wish to save your progress on the current encounter and leave it in progress. Note that doing places that encounter under the patient's Pharmacy Opportunities header of the To Do list on the patient with an "In Progress" badge.

Point of Care Test

Document the following for the POCT
- Test manufacturer
- Test lot number
- Test expiration date
- Test type
- Test result
Select Next.

Note - The appropriate testing CPT code will be added to the encounter on the backend based on the Test type selected.

Treatment

If the test is positive, you will be advanced to the Treatment page
Select the treatment you wish to prescribe and document your rationale for therapy selected, including patient preference, shared clinical decision making, etc.
Select Next.

Prophylaxis

Depending on the clinical protocol authorized in your state, the patient may qualify for prophylaxis. If the patient meets eligibility criteria, the point of care test will be bypassed, and you will be advanced to the treatment page.
Select the treatment you wish to prescribe and document your rationale for therapy selected, including patient preference, shared clinical decision making, etc.
Confirm attestations and Select Next.

Tip: Hovering over the tooltip next to the Dosage and usage text under each treatment option provides clinically relevant dosage and usage instructions for that treatment option.

Summary & Billing

Under Primary Care Provider & Follow-Up, document the patient's primary care provider information for the Provider Fax Notification.
Communicate the encounter via the Provider Fax Notification to the patient's primary care provider and provide the patient with the affiliated Visit Summary Takeaway.
Under Follow-Up, document the follow-up date.
Under Encounter Billing, document the appropriate CPT code for the encounter time from the CPT Selection drop down, the billing method, and amount collected. Note that the CPT code for the test is populated from the test type selection earlier in the workflow and the ICD 10 code is populated based on test result.
Select Next.

Please ensure you have entered all of the patient's medical insurance correctly before selecting the "Submit claim to patient's medical insurance" option.

Visit Summary

View the summary of all that you have documented for the encounter, review for accuracy, and add any additional encounter notes.
Select Submit.

Follow Up Encounter

Find the patient in the Clinical Services Upcoming queue under the Patients on the left-hand page navigation if you are documenting a follow up encounter.
Select the appropriate encounter for your state from the list of available clinical protocol templates: COVID Test and Treat - Follow-Up, Influenza Test and Treat - Follow-Up, or Strep Test and Treat - Follow-Up workflow.
In Encounter Details, document delivery method and date of encounter.
Follow the questions presented in the clinical follow up and select Next.
In Encounter Billing, indicate place of service, document the appropriate CPT code for the encounter time from the CPT Selection drop down, the billing method, and amount collected. Select Next.
- Note - PCP information and ICD 10 code will be populated from the initial workflow

View the Visit Summary of all that you have documented for the encounter, review for accuracy, and add any additional encounter notes. Select Submit.

Medical Billing Overview

If the patient is eligible and coverage requirements are met, the POCT workflows support medical billing for:

The point-of-care test performed, based on the documented test type
The evaluation and management (E/M) time associated with assessing the patient, reviewing eligibility, and making clinical decisions

Billing elements supported in the workflow include CPT code selection for encounter time, ICD‑10 diagnosis codes populated based on test results, and insurance claim submission when configured.

COVID‑19 Point of Care Testing

CPT Code	Test Method	Description	Example Test Platforms
87426	Rapid Antigen (with analyzer/reader)	Infectious agent antigen detection by immunoassay technique (qualitative or semiquantitative); SARS‑CoV or SARS‑CoV‑2	Sofia SARS COVID Antigen FIA
87811	Rapid Antigen (visual observation)	Infectious agent antigen detection by immunoassay with direct optical observation; SARS‑CoV‑2	QuickVue® SARS Rapid Antigen Test, Abbott BinaxNOW™ COVID‑19 Ag Card
87635	Rapid Molecular	Infectious agent detection by nucleic acid (DNA or RNA); SARS‑CoV‑2, amplified probe technique	Abbott ID NOW™ COVID‑19 2.0

Influenza Point of Care Testing

CPT Code	Test Method	Description	Example Test Platforms
87502	Rapid Molecular	Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, multiple types or subtypes	Abbott ID NOW™ Influenza A & B, Alere i Influenza A + B
87400	Rapid Antigen (with analyzer/reader)	Infectious agent antigen detection by immunoassay with direct optical observation; influenza	Quidel Sofia Influenza A + B FIA, BD Veritor Flu A+B
87804	Rapid Antigen (visual observation)	Infectious agent antigen detection by immunoassay technique; influenza A or B, each	Quidel QuickVue Influenza A+B

Streptococcus (Strep A) Point of Care Testing

CPT Code	Test Method	Description	Example Test Platforms
87651	Rapid Molecular	Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A	Abbott ID NOW™ Strep A 2
87430	Rapid Antigen (with analyzer/reader)	Infectious agent antigen detection by immunoassay technique; Streptococcus, group A	BD Veritor Group A Strep, Quidel Sofia Strep A+ FIA
87880	Rapid Antigen (visual observation)	Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A	Abbott BinaxNOW™ Strep A, Quidel QuickVue Dipstick Strep A

Evaluation and Management (E/M) Codes

When supported by documentation and payer requirements, the following E/M codes may be billed for the time and complexity associated with evaluating and managing the patient during the encounter:

CPT Code	Description
99202	Office or other outpatient visit, new patient, straightforward medical decision making
99203	Office or other outpatient visit, new patient, low medical decision making
99211	Office or other outpatient visit, established patient, minimal medical decision making
99212	Office or other outpatient visit, established patient, straightforward medical decision making
99213	Office or other outpatient visit, established patient, low medical decision making

It is important to note that:

The system assists with billing documentation but does not determine reimbursement
Not all patients or plans cover POCT services
Services may be documented without submitting an insurance claim

If your pharmacy uses a point‑of‑care test that is not currently listed, additional test types and CPT codes may be added. Contact Outcomes Support to request an enhancement and include details about the test method, manufacturer, and associated CPT code.