Medicare Payment Doubles for High-Production Coronavirus Lab Tests

Medicare Payment for COVID-19 Tests

CMS is boosting Medicare payment to $100 for coronavirus lab tests that can process more than 200 specimens a day effective April 14 through the duration of the national emergency.

CMS is nearly doubling Medicare payment for high-production coronavirus lab tests in efforts to boost COVID-19 testing capacity and monitoring in nursing home communities and other coronavirus hotspots.

In ruling released earlier today, CMS said it will reimburse the higher payment of $100 for COVID-19 clinical diagnostic lab tests that can process more than 200 specimens a day starting April 14, 2020, through the duration of the national emergency.

“CMS has made a critical move to ensure adequate reimbursement for advanced technology that can process a large volume of COVID-19 tests rapidly and accurately,” CMS Administrator Seema Verma stated in an announcement. “This is an absolute game-changer for nursing homes, where risk of Coronavirus infection is high among our most vulnerable.”

Nursing homes are ground zero for the COVID-19 pandemic, according to experts from Harvard. Nursing home residents are older with high levels of chronic illness and impairment, and oftentimes residents live in close quarters, making quarantine difficult.

Caregivers on the move, no paid sick leave, and high staff turnover also exacerbate the challenges of dealing with an outbreak at a nursing home, explained Michael L. Barnett, MD, MS, and David C. Grabowski, PhD.

Boosting Medicare payment for high-production coronavirus lab tests could help nursing homes and other similar healthcare settings respond quickly to COVID-19 outbreaks, CMS stated.

Medicare Administrative Contractors (MACs) currently reimburse approximately $51 for the coronavirus lab tests under the Clinical Laboratory Fee Schedule. By increasing the Medicare payment rate, CMS hopes clinical laboratories will leverage high-production lab tests for quicker detection and enhanced monitoring of COVID-19.

The high-production lab tests impacted by the new payment rate are developed by the private sector to enable “increased testing capacity, faster results, and more effective means of combating the spread of the virus,” CMS stated. The tests do so by leveraging sophisticated equipment that requires specially trained technicians, as well as time-intensive processes.

According to the ruling, examples of high-production technology include the Roche cobas 6800 System, Roche cobas 8800 System, Abbott m2000 System, Hologic Panther Fusion System, GeneXpert Infinity System, and NeuMoDx 288 Molecular.

The new $100 Medicare payment will better account for the training and resources needed to leverage the technology for COVID-19 testing, CMS stated in the ruling. The codes used to identify the tests impacted by the payment policy include U0003 and U0004.

“It is noted that U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies,” CMS stated in the ruling. “It is further noted that U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies. Finally, it is noted that neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.”

The recent announcement builds on previous CMS efforts to boost COVID-19 testing capacity. Last month, the federal agency announced that Medicare will pay for new specimen collection fees for COVID-19 testing for homebound and non-hospital inpatients. The move aimed to facilitate the testing of homebound individuals and those who are unable to travel.

CMS reported that, as a result of the payment change, laboratories have expanded COVID-19 testing capabilities in order to test more vulnerable populations, like nursing home patients. The change also led to faster results.

Hospitals have reported severe coronavirus testing shortages. A report released last week by the Office of the Inspector General at HHS revealed that testing shortages are negatively impacting the hospital system’s ability to confirm and treat COVID-19 cases while keeping staff safe.

Hospital administrators surveyed by the HHS watchdog also reported that, when testing is available, providers are waiting seven days or longer for results. These delays make it more difficult to free up capacity, personal protective equipment supplies, and staff for more patients.

Increasing coronavirus testing capacity is a top priority for the Trump administration at this time, and CMS efforts are aiming to provide better access for providers and patients to more advanced tests.

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