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

April 28, 2020

Blog Post

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.

Over the past 24 months, the U.S. Department of Health and Human Services Office for Civil Rights has brought notable enforcement efforts against several non-profit covered entities and business associates, resulting in instances of six and seven-figure penalties against providers across the county for incidents involving breaches of protected health information.

A new amendment to New York state law, which would have required all healthcare providers to obtain separate consents from patients for treatment and payment is on hold until further guidance is released, according to the New York Department of Health.

On November 1, 2024, the Centers for Medicare & Medicaid Services issued the Medicare Physician Fee Schedule 2025 final rule, which establishes new advanced primary care management billing codes that will expand opportunities for physician practices, federally qualified health centers, rural health clinics and other health care providers to get paid for services provided by clinical staff under the direction of a physician, nurse practitioner or physician assistant beginning January 1, 2025.

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

CMS focused on testing vulnerable populations

Standard COVID-19 Test Payment Rates

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