CMS doubles reimbursement rate for high-throughput COVID-19 molecular tests

April 16, 2020

The Centers for Medicare & Medicaid Services (CMS) doubled the payment for high-throughput molecular tests to detect SARS-CoV-2, the virus that causes COVID-19, the agency announced. The agency increased reimbursement for the tests from approximately $51 per test to $100.

In a separate announcement, CMS said it also it is increasing the amount hospitals are paid through the Inpatient Prospective Payment System to care for patients diagnosed with COVID-19. To do this, CMS plans to increase by 20 percent the weighting factor it uses to adjust payments to reflect patients’ severity of illness. CMS said the higher payments for hospitals are required by the Coronavirus Aid, Relief and Economic Security Act, or CARES Act.

Meanwhile, CMS Administrator Seema Verma explained the agency’s decision to increase payments for the high-throughput tests, by noting that the high-throughput tests “can process a large volume of COVID-19 tests rapidly and accurately.”

CMS also noted that high-throughput lab tests, which can process more than 200 specimens per day, are costly to run because they use “sophisticated equipment that requires specially trained technicians and more time-intensive processes to assure quality.”

The new payment rate went into effect on April 14, 2020 and lasts through the duration of the COVID-19 pandemic.

Examples of high-throughput technology platforms, according to CMS, include the Roche cobas 6800 System, Roche cobas 8800 System, Abbott m2000 System, Hologic Panther Fusion System, GeneXpert Infinity System, and NeuMoDx 288 Molecular.

For other COVID-19 laboratory tests, local Medicare Administrative Contractors (MACs) remain responsible for developing the payment amount in their respective jurisdictions, CMS said. MACs are currently paying approximately $51 for those tests, the agency said.

In response to CMS’ decision, American Clinical Laboratory Association (ACLA) President Julie Khani said in a statement, “We know that the lack of predictable reimbursement for tests performed has been a barrier to entry for some laboratories, and this decision will help encourage all laboratories with the appropriate expertise to come to the table and perform COVID-19 testing. We also hope that other payers will follow CMS’s strong example of leadership.”

Khani, whose organization has been lobbying for increased reimbursement for COVID-19 testing, also said that ACLA members have completed more than 2 million COVID-19 tests since the Food and Drug Administration (FDA) issued a guidance that allowed commercial laboratories to perform the tests.

CMS has the rulings.

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