CMS Updates Payment For Certain COVID-19 Lab Tests

By Brenda Turner, director of product consulting, MedeAnalytics.

Brenda Turner

The COVID-19 landscape as it relates to testing is frequently changing as CMS made wholesale changes and smaller adjustments to payment schedules.

CMS announced Medicare will nearly double payment for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of 2019 Novel Coronavirus (COVID-19) cases.

Medicare will pay the higher payment of $100 for COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allows for increased testing capacity, faster results, and more effective means of combating the spread of the virus. High-throughput lab tests can process more than 200 specimens a day using highly sophisticated equipment requiring specially-trained technicians and more time-intensive processes to ensure quality. Medicare will pay laboratories for the tests at $100 per test effective April 14, 2020, through the duration of the COVID-19 national emergency.

CMS and the US Departments of Labor and Treasury issued guidance to ensure Americans with private health insurance have coverage of COVID-19 diagnostic testing and certain other related services, including antibody testing, at no cost.

Specifically, the requirement for group health plans, and group and individual health insurance is to cover both diagnostic testing, and certain related items and services provided during a medical visit with no cost-sharing. This includes urgent care visits, emergency department visits, and in-person or telehealth visits to the doctor’s office that result in an order for or administration of a COVID-19 test.

Covered tests include all FDA-authorized COVID-19 diagnostic tests, COVID-19 diagnostic tests that developers request authorization for on an emergency basis, and COVID-19 diagnostic tests developed in and authorized by states. It also ensures that COVID-19 antibody testing also will be covered.

The initial pricing for the new codes U0001 and U0002 for the Centers for Disease Control and Prevention (CDC) test will be approximately $36 and non-CDC tests will initially be approximately $51. These prices may vary slightly depending on the local Medicare Administrative Contractor (MAC).

National, Private Insurers Pay for COVID-19 Testing

In March, several national insurers committed to paying for diagnostic testing for COVID-19 without cost-sharing, like copays and coinsurance, and many have since said they’ll waive cost-sharing for inpatient treatment as well. The April 11 guidance implements the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security Act, which requires private health plans and employer group health plans to cover COVID-19 testing with no out-of-pocket expenses.

The coverage requirement includes no cost-sharing for “certain related items and services” provided during a medical visit for COVID-19 testing. CMS said this means insurers must cover urgent care visits, emergency department visits and in-person or telehealth visits that result in an order for a COVID-19 test. Additionally, the guidance ensures coverage of COVID-19 antibody testing.

CMS said it sees the antibody test as a “key element in fighting the pandemic by providing a more accurate measure of how many people have been infected and potentially enabling Americans to get back to work more quickly.”

Additional information about these updates and other COVID-19 details can be found at:

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