Published March 16, 2020
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The Centers for Medicare and Medicaid Services (CMS) recently announced that testing for COVID-19 would be fully covered. Private health insurance companies soon followed suit.
On March 16, the CMS released details about how COVID-19 testing would be reimbursed to health care providers administering the tests.
Laboratories using the test developed by the Center for Disease Control and Prevention (CDC) would be reimbursed $36 per test. Those using a non-CDC test will be reimbursed $51 per test.
CMS noted that the exact reimbursement amounts may vary slightly according to the local Medicare Administrative Contractor (MAC), but all local rates are within a dollar of the above rates. Providers will rely on the established reimbursement rates for their region until a national payment rate is installed.
COVID-19 testing is covered by Medicare Part B when a test is ordered by a doctor or other health care provider. The Part B deductible will not apply, as the COVID-19 test falls under the category of clinical diagnostic laboratory tests that are included under Part B coverage.
Medicare Advantage plans (Medicare Part C) are required by law to provide at least the same benefits as Original Medicare. This means that Medicare Advantage plans also cover the cost of COVID-19 tests.
In addition to the reimbursement amounts, CMS also made clear the Healthcare Common Procedure Coding System (HCPCS) billing codes that would be used to identify COVID-19 testing for labs and health care providers.
Code U0001 identifies diagnostic testing performed by laboratories using a CDC-developed COVID-19 test. Code U0002 will be used for all non-CDC lab test for COVID-19, including those developed in-house according to new Federal Drug Administration (FDA) guidelines.
Health care providers administering COVID-19 tests must wait until April 1 to submit a claim to Medicare.
Private health insurers, Medicaid and the Children’s Health Insurance Program (CHIP) will also be covering COVID-19 tests at no cost. And the CDC announced that it will not be charging any out-of-pocket costs to uninsured persons for the test.
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