• Ritu Shah

Medicare now covers COVID-19 testing - Medicare Part B

COVID-19 Testing

Physician ordered COVID-19 test is covered with no cost- sharing in either traditional Medicare or an MA plan.

Medicare will pay laboratory technicians to travel to a beneficiary’s home to collect a specimen for COVID-19 testing, eliminating the need for the beneficiary to travel to a healthcare facility for a test and risk exposure to themselves or others. There will be additional payment during the Public Health Emergency (PHE) in the form of a specimen collection fee of $23.46 generally, and $25.46 for an individual in a SNF or by a laboratory on behalf of a Home Health Agencies, for COVID–19 testing and to provide a travel allowance for a laboratory technician to collect a specimen for COVID–19 testing from a non-hospital inpatients or homebound patients.

Medicare Part B will cover beneficiary cost-sharing for provider visits during which a COVID-19 diagnostic test is administered or ordered.

Note: this does not mean that all COVID related treatment is covered without cost-sharing; according to CMS, “cost-sharing does not apply for COVID-19 testing-related services, which are medical visits that: are furnished between March 18, 2020 and the end of the Public Health Emergency (PHE); that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test; and are in any of [certain] categories of HCPCS evaluation and management codes”

Website link for more information:

CMS Increases Medicare Payment for High-Production Coronavirus Lab Tests

Medicare will pay the higher payment of $100 for COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results, and more effective means of combating the spread of the virus.High-throughput lab tests can process more than two hundred specimens a day using highly sophisticated equipment that requires specially trained technicians and more time-intensive processes to assure quality. Medicare will pay laboratories for the tests at $100 effective April 14, 2020, through the duration of the COVID-19 national emergency.

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