Reimbursement of COVID-19 Testing: Medicare

How about some good news for a change? On April 15, CMS announced that it was increasing reimbursements for high-throughput SARS-CoV-2 lab tests. Here are the three key takeaways.

  1. Which Tests Qualify for the Increase

The reimbursement bump applies to tests using high-throughput technologies allowing for increased capacity and faster results. High-throughput tests, CMS explains, can process at least 200 specimens per day using “highly sophisticated equipment that requires specially trained technicians and more time-intensive processes to assure quality.” The agency lists examples of high-throughput technology, including:

  • Roche’s Cobas 6800 and 8800 systems;
  • Abbott’s m2000 system;
  • Hologic’s Panther Fusion system;
  • Cepheid’s GeneXpert’s Infinity system; and
  • NeuMoDx’s 288 Molecular system.
  1. The New Reimbursement Rates

Starting with tests performed on April 14, CMS will pay $100 for eligible SARS-CoV-2 high-throughput tests. That’s a significant increase from the original rate set in March as $35.91 or $35.92 for labs using the test developed by the US Centers for Disease Control and Prevention, and between $51.31 and $51.33 for non-CDC tests. Reimbursement for tests that don’t use high-throughput technology will remain subject to Medicare Administrative Contractors discretion, with the current going rate of about $51 per test.

  1. Which Billing Code to Use

Labs can bill for COVID-19 tests using:

  • Code U0003 for PCR-based coronavirus tests; and
  • Code U0004 for tests using any technique with high-throughput technology.