CMS increases payment for rapid-result COVID-19 laboratory tests

April 20, 2020

Medicare Web

CMS on April 14 released a ruling that nearly doubles Medicare Part B payment for rapid-result COVID-19 laboratory tests from about $51 per test to $100 per test. The payment increase applies to tests performed on or after March 18 and remains in effect until the end of the public health emergency.

The payment increase specifically applies to clinical diagnostic lab tests (CDLT) for COVID-19 performed using “high-throughput technology.” CMS defines high-throughput technology as laboratory tests utilizing a platform that “employs automated processing of more than two hundred specimens a day.” The increased payment amount accounts for the specially trained personnel and intensive processes necessary to ensure testing accuracy. These rapid-result tests will allow for increased testing capacity and faster results to help mitigate the spread of COVID-19, according to CMS

CMS created the following HCPCS Level II codes to identify these CDLT tests:

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
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

In its ruling, CMS also notes the following:

Code U0003 identifies tests that would otherwise be identified by CPT code 87635 (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) but performed with these high-throughput technologies.
Code U0004 identifies tests that would otherwise be identified by U0002 but performed with these high-throughput technologies.
Neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.
Payment for all other CDLTs remains at the current level.