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.
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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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Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.