The Centers for Medicare and Medicaid Services (CMS) recently announced a change in Medicare policy affecting when an order is required for COVID-19 and related tests. Medicare beneficiaries will now be permitted to have one COVID-19 diagnostic test, one influenza test and one respiratory syncytial virus (RSV) test without a physician or other practitioner order. All subsequent tests must be pursuant to an order to be reimbursable by Medicare. The change in policy was included in the third interim final rule with comment (IFC-3) that CMS released on August 25, 2020.  In the IFC-3, CMS announced:

“[W]e are revising the previous policy adopted in the May 8th COVID-19 IFC, which allowed for broad coverage of multiple instances of COVID-19 testing for a single beneficiary without a physician or other practitioner order, by establishing that one single COVID-19 diagnostic test and one of each other related test (as listed in the May 8th COVID-19 IFC) without an order from a physician or other practitioner is reasonable and necessary. This limitation on tests without a physician/other practitioner order will apply beginning on the effective date of this rule, and any tests furnished prior to the effective date will not be considered for purposes of this limit on tests without a physician or other practitioner order. In other words, if a beneficiary received a test or multiple tests without an order before the effective date of this rule, these tests would not count toward the limit of one test without a physician or other practitioner order under this rule.”

The list of COVID-19, influenza and RSV clinical diagnostic laboratory tests affected by this change in policy is located on the CMS website.  This revised policy is effective as of the date of the publication of the IFC-3 in the Federal Register, which is scheduled for September 2, 2020.

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