Medicare Reimbursement

New CMS Waivers Dramatically Expand Coverage Rules for COVID-19 Testing

CMS doesn’t want the usual compliance red tape to stand in the way of desperately needed COVID-19 testing. So, on May 1, the agency issued regulatory waivers temporarily expanding coverage of testing for Medicare and Medicaid beneficiaries. Here are the five key changes:

  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. No Need for Written Order

CMS will also waive the requirement of a written practitioner’s order for purposes of Medicare reimbursement for the COVID-19 test.

  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. Green Light for Evaluation & Sample Collection by Hospitals & Practitioners

CMS will also pay hospitals and practitioners to evaluate beneficiaries and collect lab samples for SARS-CoV-2 tests, and will provide separate payment when it’s the only service the patient receives.

  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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