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CMS Revises Medicare Reimbursement Rate for COVID-19 Testing

According to a recent announcement, CMS will decrease the base Medicare reimbursement rate for COVID-19 studies conducted by laboratories making use of high throughput technology. The announcement made late last week declared that, according to the revised Administrative Ruling (CMS-2020-1-R2), the rate would decrease to $75 from $100 starting in 2021.

At the height of the COVID-19 pandemic, CMS had increased the Medicare payment limit for high throughput COVID-19 research from about $51 to $100. However, should labs complete COVID-19 experiments within two calendar dates of the specimen being obtained, labs will be eligible to charge at the higher cost of $100, the regulation also specified.

Under the modified rule, labs using high-throughput COVID-19 research technology must have the ability to complete diagnostic tests within a pair of calendar days or less in order to apply for the higher reimbursement rate. This applies to the majority of patients versus solely those under Medicare.

The new Medicare payment rates are designed to encourage quicker, high-throughput research that will allow patients and clinicians to respond rapidly and resolutely with regard to their options for treatment, contact tracing, and more. Using an automated method that can administer more than 200 daily, high-throughput technologies allow improved testing power.

Laboratories would need to utilize the Healthcare Common Procedure Coding System (HCPCS) code U0005 to obtain a higher reimbursement rate and meet revised coding guidelines, which were also issued last week.

To read more, please visit https://revcycleintelligence.com/news/cms-reduces-medicare-reimbursement-rate-for-some-covid-19-tests.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.