CMS Releases Medicare Reimbursement Details for COVID-19 Tests

Following the development of new billing codes, CMS is now letting clinical laboratories know how much they will receive in Medicare reimbursement for testing patients for COVID-19.

CMS emailed providers last week with a pricing list for COVID-19 diagnostic tests. The list stated that laboratories testing patients for the novel coronavirus using the CDC’s test will receive about $36 in Medicare reimbursement, while those non-CDC test kits will receive about $51.

However, CMS pointed out in the email that “prices may vary slightly depending on the local Medicare Administrative Contractor (MAC).”

On March 5 and February 13, CMS announced new Healthcare Common Procedure Coding System (HCPCS) codes for healthcare providers and laboratories to test patients for COVID-19.

One HCPCS code (U0001) is designed to capture diagnostic testing performed by qualified laboratories using CDC-developed tests. The other code (U0002) can be used to bill for all non-CDC laboratory tests for COVID-19, including those developed in-house according to new FDA guidelines.

CMS Administrator Seema Verma stated earlier this month that the billing codes will “help encourage doctors and laboratories to use these essential tests for patients who need them.”

According to the latest data from a new dashboard created by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, there are over 169,000 confirmed cases of COVID-19 worldwide. Of these cases, 3,774 are in the US at the time of publication.

Now deemed a pandemic by the World Health Organization, COVID-19 is putting significant strain on the healthcare system, especially here in the US. Industry leaders have voiced concerns that resources are not enough to manage a massive influx of infected individuals.

“There are about 46,500 medical ICU beds in the United States and perhaps an equal number of other ICU beds that could be used in a crisis. Even spread out over several months, the mismatch between demand and resources is clear,” experts from the Johns Hopkins Bloomberg School of Public Health recently stated.

New research on the impact of COVID-19 published in Lancet showed that the number of patients requiring intensive care daily ranged between 9 and 11 percent in Italy where the virus has infected over 24,747 patients to date.

That number is down from 26 percent of infected patients in a smaller cohort of individuals in Wuhan, China where COVID-19 originated. However, researchers examining COVID-19 in Italy warned that intensive care units will be at maximum capacity if the infection trend continues for just one more week.

“Intensive care specialists are already considering denying life-saving care to the sickest and giving priority to those patients most likely to survive when deciding who to provide ventilation to,” the researchers wrote. “In the near future, they will have no choice. They will have to follow the same rules that health-care workers are left with in conflict and disaster zones.”

Industry experts fear the US could be in this boat shortly given the rapid spread of COVID-19. Conservative estimates suggest that the US healthcare system could need almost twice the amount of critical care beds if the pandemic looks like previous flu outbreaks.

Diagnostic testing will be key to controlling the spread of the virus and managing hospital capacity.

“Americans need access to rapid diagnostic testing. The sooner clinicians, patients, and public health officials know whether someone is infected with the novel coronavirus, the sooner they can take action to mitigate the spread of COVID-19,” said Rick A. Bright, PhD, director of Biomedical Advanced Research and Development Authority (BARDA) within HHS.

“Rapid diagnostic tests are critical in this public health response. We are working with the private sector at an urgent pace to make these tests available on as many diagnostic platforms as we can in the coming weeks.”

In a time when hospitals are scaling back services in response to the outbreak, providers can rely on the new Medicare reimbursement rates for their region until the program can establish national payment rates.