Medicare Reimbursement

CMS Waivers Expand COVID-19 Testing Coverage Rules

On May 1, CMS issued regulatory waivers temporarily expanding coverage and clarifying billing of COVID-19 testing for Medicare and Medicaid beneficiaries during the public health emergency (PHE). Here are the five key takeaways.

  1. CPT Coding

Labs can be paid for assessment and specimen collection for COVID-19 testing using the level 1 evaluation and management code CPT 99211. (See the related story on specimen collection fees on page X.) During the PHE, CMS will recognize this code for billing all patients, not just established patients.

  1. No Need for Written Order

CMS will also waive the requirement of a written practitioner’s order for purposes of Medicare reimbursement of COVID-19 tests, including tests to confirm or rule out COVID-19. CMS still expects to furnish test results to beneficiaries, typically within 24 hours.

  1. Expansion of Eligible Test Orderers

CMS will no longer require an order from a treating physician or other practitioner for a beneficiary to get tested for COVID-19 but will cover testing ordered by any healthcare professional authorized to order tests under state law. The waiver also applies to other tests required as part of coronavirus testing.

  1. Green Light for Evaluation & Sample Collection by Pharmacists

Another CMS waiver allows pharmacists to work with practitioners to evaluate beneficiaries and collect samples for testing. Practitioners may bill Medicare for these services. To clear the way for drive-through testing, pharmacists enrolled in Medicare may perform certain COVID-19, in accordance with state law and licensing requirements.

  1. Coverage of Serology Tests

Last but not least, CMS said that Medicare and Medicaid will pay for coronavirus serology tests. The two programs will cover lab processing of certain FDA-authorized tests that beneficiaries self-collect at home.

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