On April 14, 2020, CMS released a ruling that will increase the reimbursement for tests conducted to detect SARS–CoV–2 (the diagnosis of the virus that causes COVID–19) for tests utilizing “high throughput technologies.” The reimbursement under Medicare Part B for these laboratory tests will be raised from about $51 per test to $100 per test. This increase will begin with tests performed on or after March 18, 2020 and end when the national emergency is over.
It is important to note that these increased rates only apply to tests done using high throughput technology. CMS defines “high throughput technology” as tests utilizing a platform that “employs automated processing of more than two hundred specimens a day.” CMS Administrator Seema Verma said that the agency increased the payment for this technology because the platforms are able to “process a large volume of COVID-19 tests rapidly and accurately” and will allow more people to be tested faster. Examples of this technology available as of April 14, 2020 include the Roche cobas 6800 System, Roche cobas 8800 System, Abbott m2000 System, Hologic Panther Fusion System, GeneXpert Infinity System, and NeuMoDx 288 Molecular. Furthermore, providers utilizing such technology should identify the tests using the new CPT Codes, which are U0003 (for the amplified probe technique that makes use of high throughput technologies) and U0004 (for any technique, non-CDC, making use of high throughput technologies).
The types of tests discussed here are clinical diagnostic laboratory tests (CDLTs), which are paid for on the Clinical Laboratory Fee Schedule. For any other COVID-19 laboratory tests, Local Medicare Administrative Contractors will remain responsible for developing payment amounts in their particular jurisdictions.
This ruling comes on the heels of CMS’ efforts to increase testing. On March 30, 2020, 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. On April 8, 2020, CMS issued guidance, which provided that pharmacists could begin to order and administer tests. By increasing the payment for these CDLTs, CMS said that it hopes to expand testing among the most vulnerable population, like nursing and homebound patients.
