CMS Alters High-Throughput COVID-19 Payment Rates, Again

Seema Verma, the Administrator of the Centers for Medicare and Medicaid Services (CMS), unveiled a new payment policy for COVID-19 testing on Oct. 15. The new policy, outlined in detail in an Administrative Ruling, is intended to incentivize faster turnaround testing for high-throughput COVID-19 diagnostic testing. Currently, the payment rate for these tests is $100. Under the new policy, which will go into effect on January 1, 2021, CMS will lower the payment the rate to $75 and create a new add-on code of $25. In order for laboratories to bill for the new add-on code, U0005, the test would (1) have to be completed within 48 hours of specimen collection, AND (2) require that 51 percent of all COVID-19 high-throughput diagnostic tests performed in the previous month would have to have been performed within 48 hours.

The medical community has noted that rapid test turnaround time for COVID-19 diagnostic tests is necessary to optimize healthy patient outcomes and to improve the effectiveness of the containment of the COVID-19 pandemic. ASCP supports the intent of the policy; however, it will be raising concerns that it is imperative for the federal government to help ensure that laboratory supply shortages do not interfere with the ability of clinical laboratories to meet the rapid turnaround time requirements necessary to secure the add-on payment.

To learn more about ePolicy News and access past newsletters and articles, click here.

For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.  

ASCP ePolicy News is supported by an unrestricted grant from Hologic.