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.
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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.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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