CMS increases Medicare payment for COVID-19 lab tests using high-production equipment

The Centers for Medicare and Medicaid Services (CMS) issued a new payment ruling and announced that effective April 14, 2020, and through the remainder of the emergency period, Medicare will pay $100 under Part B for each COVID-19 clinical diagnostic laboratory test (CDLT) processed using “high-throughput” equipment, including but not limited to the following:

• Roche cobas 6800 System
• Roche cobas 8800 System
• Abbott m2000 System
• Hologic Panther Fusion System
• GeneXpert Infinity System
• NeuMoDx 288 Molecular

According to CMS, this high-throughput technology can process over 200 specimens per day and requires specially trained technicians engaged in time-intensive processes to assure quality, therefore justifying this payment increase. However, it remains unclear whether Medicare will accept increased payment claims for tests processed prior to the ruling’s effective date.

New test codes

• U0003: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies.
  • U0003 should identify tests that would otherwise be identified by CPT code 87635 but are now done on the above identified or similar equipment.
• U0004: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies.
  • U0004 should identify tests that would otherwise be identified by U0002 but are now done on the above identified or similar equipment.

NOTE: Neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.

CMS focused on testing vulnerable populations

This action from CMS follows the current administration’s efforts to expand access to testing and increase the ability to monitor high-vulnerability populations, such as nursing homes and long-term care facilities where the COVID-19 infection rate is much higher than in other healthcare settings or amongst the general population.

Standard COVID-19 Test Payment Rates

For other types of COVID-19 laboratory tests, local Medicare Administrative Contractors (MACs) are responsible for developing payment rates in their respective jurisdictions, which are approximately $51 per test. Generally, there should be no beneficiary cost-sharing obligations under original Medicare plans for COVID-19 testing.