Published October 22, 2020
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Starting Jan. 1, Medicare will reward labs that return a COVID-19 test result in two days or less.
Beginning in 2021, the Centers for Medicare and Medicaid Services (CMS) will pay labs $100 for each COVID-19 test that is completed on a high-volume machine within two days of collecting the specimen. Labs that take longer than two days will be reimbursed for just $75.
Many labs around the U.S. have been taking a week or more to return test results as cases have spiked. The delayed test results present a hurdle for performing contact tracing for positive results.
In April, Medicare announced it would reimburse $100 for each test conducted on a “high-throughput” machine, which are designed to process a large volume of tests in a short amount of time. That was an increase from typical Medicare reimbursements rates of around $51 per test.
But the latest Medicare policy now states that even on the high-throughput machines, test results must be returned within two days to qualify for the full $100 reimbursement. Plus, those labs must demonstrate a two-day turnaround for the majority of their COVID-19 tests over the previous 30 days in order to remain eligible for the full reimbursement. All other test reimbursements will remain at the $75 rate.
“As America continues to grapple with the COVID-19 pandemic, prompt testing turnaround times are more important than ever. Today’s announcement supports faster high-throughput testing, which will allow patients and physicians to act quickly and decisively with respect to treatment decisions, physical isolation, and contact tracing.” - CMS Administrator Seema Verma1
Medicare covers the full cost of a COVID-19 test when performed in a laboratory, pharmacy, doctor’s office or hospital. Medicare also covers a COVID-19 antibody or “serology” test to determine if a patient has developed an immune response to the novel coronavirus and may not be at immediate risk of another COVID-19 infection.
Learn more about Medicare news and how the COVID-19 pandemic affects beneficiaries.
1 CMS. (Oct. 15, 2020). CMS Changes Medicare Payment to Support Faster COVID-19 Diagnostic Testing [press release]. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-changes-medicare-payment-support-faster-covid-19-diagnostic-testing.