CMS NEWS
FOR IMMEDIATE RELEASE
April 15, 2020
CMS Increases Medicare Payment for
High-Production Coronavirus Lab Tests
CMS helps expand testing capacity and
monitoring for COVID-19 in nursing homes and other settings with high
volume testing needs
Under President
Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS)
today announced Medicare will nearly double payment for certain lab tests
that use high-throughput technologies to rapidly diagnose large numbers of
2019 Novel Coronavirus (COVID-19) cases. This is another action the Trump
Administration is taking to rapidly expand COVID-19 testing, particularly
for those with Medicare, including nursing home residents who are among the
most vulnerable to COVID-19 and most affected by COVID-19 outbreaks across
the country.
“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.”
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. High-throughput lab
tests can process more than two hundred specimens a day using highly
sophisticated equipment that requires specially trained technicians and
more time-intensive processes to assure quality. Medicare will pay
laboratories for the tests at $100 effective April 14, 2020, through the
duration of the COVID-19 national emergency.
Increasing Medicare
payment for these tests will help laboratories test in nursing home
communities that are vulnerable to the spread of COVID-19. On March 30,
2020, CMS announced that Medicare will pay new specimen collection fees for
COVID-19 testing for homebound and non-hospital inpatients, to help
facilitate the testing of homebound individuals and those unable to travel.
As a result of these actions, laboratories will have expanded capability to
test more vulnerable populations, like nursing home patients, quickly and
provide results faster.
For other COVID-19
laboratory tests, local Medicare Administrative Contractors (MACs) 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.
This announcement
builds upon recent CMS actions to expand testing for COVID-19. 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. This will both increase access to testing
and reduce risks of exposure. Additionally, CMS took action to allow
healthcare systems, hospitals, and communities to set up testing sites to
identify COVID-19-positive patients in a safe environment.
Increasing Medicare
payment for tests that use high-throughput technologies, and earlier CMS
actions in response to COVID-19, are part of the ongoing White House
Coronavirus Task Force efforts. To keep up with the important work the Task
Force is doing in response to COVID-19, visit www.coronavirus.gov. For
a complete and updated list of CMS actions, and other information specific
to CMS, please visit the Current
Emergencies Website.
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