New Medicare 2021 Pay Rule Penalizes Labs for Long COVID-19 Test Turnaround Times
On Oct. 15, CMS announced new Medicare reimbursement policies designed to cut turnaround time and speed up processing of COVID-19 tests. Medicare Reimbursement of COVID-19 Testing When the public health emergency first began, Medicare paid labs $51 per test for high throughput COVID-19 diagnostic tests. Recognizing that the rate was inadequate, CMS raised it to $100 per test. However, new effective Jan. 1, 2021, labs will only qualify for the $100 payment rate if they complete the test within two calendar days of collecting the specimen. Labs that take longer than two days will be paid only $75 per test. The Way It Works Technically, the amended Administrative Ruling (CMS 2020-1-R2) lowers the base rate payment amount for COVID-19 diagnostic tests run on high throughput technology to $75. However, labs will qualify for a $25 add-on payment if: They complete the billed test in two calendar days or less; AND They complete the majority of high throughput COVID-19 tests in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month. Labs that qualify will use HCPCS code U0005 to bill for the add-on payment. Labs that fail to meet the add-on […]
- They complete the billed test in two calendar days or less; AND
- They complete the majority of high throughput COVID-19 tests in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month.
Subscribe to view Essential
Start a Free Trial for immediate access to this article