CMS Increasing Medicare Payments for High-Throughput COVID-19 Tests

The Center for Medicare & Medicaid Services (CMS) has announced that it is increasing payments under Medicare for high-throughput COVID-19 clinical diagnostic laboratory tests. Previously, Medicare Administrative Contractors were paying out $51 for these tests. Under the new payment policy, effective April 14, 2020, Medicare will pay $100 (nearly double the previous amount) for such tests for the duration of the COVID-19 national emergency.

Specifically, CMS will pay $100 for COVID-19 clinical diagnostic laboratory tests in the private sector that make use of high-throughput technologies. High-throughput COVID-19 tests utilize highly sophisticated equipment that require specially trained technicians and time-intensive processes to deliver accurate results. These types of tests are able to process more than two hundred (200) specimens each day. Examples of high-throughput laboratory testing technology include but are not limited to: Roche Cobas 6800 System, Roche Cobas 8800 System, Abbott m2000 System, Hologic Panther Fusion System, GeneXpert Infinity System and NeuMoDx 288 Molecular.

CMS’ new payment policy is intended to rapidly expand COVID-19 testing, particularly to those with Medicare, to more effectively combat the COVID-19 pandemic. Moreover, CMS believes the increased laboratory test payments will aid highly vulnerable facilities (e.g., nursing homes) in detecting COVID-19-positive patients more rapidly and accurately. CMS has already taken numerous steps to mitigate the spread of COVID-19 in nursing homes, which have been a hotbed for COVID-19. The HLP discussed CMS’ prior actions to mitigate the spread of COVID-19 in nursing homes in a previous blog. By issuing this policy update, CMS intends, in part, to further curb the spread of COVID-19 in nursing homes.

Please note that the payment increase under this policy only applies to high-throughput COVID-19 diagnostic laboratory tests. All other clinical diagnostic laboratory tests will be paid out in accordance with the Clinical Laboratory Fee Schedule.

For more information regarding the CMS’ updated payment policy for high-throughput COVID-19 laboratory tests, please contact your regular HLP attorney, or, or call (212) 734-0128 or (248) 996-8510.

Contact Information