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    CMS Seeks Faster COVID-19 Lab Results

    Posted by Carl Mays, ClaimCare President/CEO on Fri, Oct 16, 2020 @ 01:03 PM

    CMS Seeks Faster COVID-19 Lab Results

    CMS is working to ensure that patients who test positive for the virus are alerted quickly so they can self-isolate and receive medical treatment. Thus, under President Trump’s leadership, the Centers for Medicare & Medicaid Services posted an October 15 announcement of new actions to pay for expedited COVID-19 test results.


    Back on April 15, CMS Administrator Seema Verma announced, “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.” At that time, Medicare payment to laboratories for high throughput COVID-19 diagnostic tests was increased from approximately $51 to $100 per test.

    Now, to encourage labs to increase the rapidity in receiving results, beginning January 1, 2021, Medicare will pay $100 only to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen being collected. Medicare will pay a rate of $75 to laboratories that take longer than two days to complete these tests, effective also on January 1, 2021.

    “As America continues to grapple with the COVID-19 pandemic, prompt testing turnaround times are more important than ever,” said CMS Administrator Seema Verma. This updated payment announcement “supports faster high throughput testing, which will allow patients and physicians to act quickly and decisively with respect to treatment decisions, physical isolation, and contact tracing. President Trump continues to lead the most robust testing effort anywhere in the world.”

    Amended Administrative Ruling (CMS 2020-1-R2)

    This amended ruling, effective January 1, 2021, lowers the base payment amount for COVID-19 diagnostic tests run on high-throughput technology from $100 to $75 in accordance with CMS’s assessment of the resources needed to perform those tests.

    Then, Medicare will make an additional $25 add-on payment to laboratories for a COVID-19 diagnostic tests run on high-throughput technology if the laboratory: (1) completes the test in two calendar days or less, and (2) completes the majority of their COVID-19 diagnostic tests that use high throughput technology in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month.

    HCPCS Code U0005

    CMS established these requirements to support faster high throughput COVID-19 diagnostic testing and to ensure all patients (not just Medicare patients) benefit from faster testing. These actions will be implemented under the amended Administrative Ruling (CMS-2020-1-R2) and coding instructions for the $25 add-on payment (HCPCS Code U0005) released October 15.

    According to CMS, “The new payment amounts effective January 1, 2021 ($100 and $75) reflect the resource costs laboratories face for completing COVID-19 diagnostics tests using high throughput technology in a timely fashion during the Public Health Emergency."

    Impact on Laboratories

    This CMS update may have an impact on laboratories’ logistics and/or sample collections beginning with dates of service from January 21, 2021, forward. Please note that the two-day clock starts when the sample is COLLECTED, not when it is received by the lab.

    It appears this updated policy is measured on a monthly basis. The two scenarios seem to be:

       1. In the prior month, the lab completes the majority of ALL COVID-19 tests (across all payers, not just Medicare) in 2 days or less from sample collection, and the two codes are billed: 
           a. COVID-19 test (U0004), which will pay $75
           b. Fast completion code (U0005), which will pay $25 

       2. In the prior month, the lab does not complete the majority of ALL COVID-19 tests (across all payers, not just Medicare) in 2 days or less from sample collection, and the one code is billed: 
           a. COVID-19 test (U0004), which will pay $75

    Questions Will Be Asked

    Undoubtedly, laboratories will have questions regarding this updated policy, and I feel sure additional information will be coming from CMS to answer such questions as:

    1. What does “majority” mean? Simple majority? Super majority?  
    1. Do both the test being billed AND the majority of tests from prior months need to be completed in two days or less? If you visit the CMS source, the text is not clear on this point.  
    1. What if the issue is with the sample source and not with the lab when it comes to missing the two-day mark?

     When ClaimCare uncovers more information regarding this updated policy, we will posting it via our blogs.


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    Tags: Medicaid billing, COVID-19 Medical Reimbursement, COVID-19, Medicare & Medicaid

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