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CMS increases Medicare payment for high-production coronavirus lab tests

The action is being taken to rapidly expand COVID-19 testing, particularly for those with Medicare and in nursing homes.

Susan Morse, Managing Editor

Medicare will nearly double the payment for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of 2019 Novel Coronavirus cases, the Centers for Medicare and Medicaid Services announced today.

Medicare will pay the higher payment of $100 for COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results and more effective means of combating the spread of the virus, CMS said.

Medicare will pay laboratories for the tests at $100 effective April 14, through the duration of the COVID-19 national emergency.

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High-throughput lab tests can process more than 200 specimens a day using sophisticated equipment that requires specially trained technicians and more time-intensive processes to assure quality.

For other COVID-19 laboratory tests, local Medicare Administrative Contractors remain responsible for developing the payment amount in their respective jurisdictions. MACs are currently paying approximately $51 for those tests. As with other laboratory tests, there is generally no beneficiary cost-sharing under original Medicare.

WHY THIS MATTERS

The action is being taken to rapidly expand COVID-19 testing, particularly for those with Medicare, including nursing home residents. Laboratories will have expanded capability to quickly test more vulnerable populations, like nursing home patients, and provide results faster, CMS said.

Nursing home residents are among the most vulnerable to COVID-19.

More than 3,600 COVID-19 deaths of the more than 27,000 deaths in the U.S. are believed to be linked to nursing homes and assisted living centers, according to PBS.org.

THE LARGER TREND

The announcement builds upon recent CMS actions to expand testing for COVID-19. On March 30, CMS announced that hospitals, laboratories, and other entities can perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital. CMS said Medicare would pay new specimen-collection fees for COVID-19 testing for homebound and non-hospital inpatients.

Additionally, CMS took action to allow healthcare systems, hospitals and communities to set up testing sites to identify COVID-19-positive patients.

The efforts arose from White House Coronavirus Task Force.

ON THE RECORD

"CMS has made a critical move to ensure adequate reimbursement for advanced technology that can process a large volume of COVID-19 tests rapidly and accurately," said CMS Administrator Seema Verma. "This is an absolute game-changer for nursing homes, where risk of coronavirus infection is high among our most vulnerable."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com