{"id":11186,"date":"2020-05-08T15:00:16","date_gmt":"2020-05-08T09:30:16","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=11186"},"modified":"2026-05-11T11:15:34","modified_gmt":"2026-05-11T11:15:34","slug":"medicare-increases-payment-for-high-production-coronavirus-lab-tests","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-increases-payment-for-high-production-coronavirus-lab-tests\/","title":{"rendered":"Medicare Increases Payment for High-Production Coronavirus Lab Tests"},"content":{"rendered":"

This announcement made by CMS-Rulings on 14th<\/sup> April 2020.<\/p>\n

CMS-Rulings provide clarification and interpretation of complex or ambiguous statutory or regulatory provisions relating to Medicare, Medicaid, Utilization and Quality Control Peer Review, private health insurance, and related matters. This Ruling articulates CMS policy concerning the designation and payment of certain clinical diagnostic laboratory tests related to COVID-19 under the Medicare Part B Clinical Laboratory Fee Schedule.<\/p>\n

Background:<\/strong> Payment under Medicare Supplementary Medical Insurance (Part B) for clinical diagnostic laboratory tests for the detection of SARS\u2013CoV\u20132 or the diagnosis of the virus that causes COVID\u201319 making use of high throughput technologies.<\/p>\n

Medicare Part B items and services that are clinical diagnostic laboratory tests (CDLTs) are paid for on the Clinical Laboratory Fee Schedule in accordance with section 1833(h) and section 1834A of the Social Security Act (the Act). CMS and the Medicare Administrative Contractors (MACs) that process Medicare claims for payment make payment based on the Act, regulations, and CMS instructions or guidance. Sections 1833(h) and section 1834A of the Act contain provisions outlining the process for determining payment amounts for CDLTs. CDLTs are currently being used to detect SARS\u2013CoV\u20132 or for the diagnosis of the virus that causes COVID\u201319 in many settings, including nursing homes and other sites where Medicare beneficiaries obtain care or reside.<\/p>\n

Payment for laboratory tests<\/h2>\n

CDLTs making use of high throughput technologies (as defined in this Ruling) and administered during the ongoing emergency period defined in paragraph (1)(B) of section 1135(g) of the Act beginning on or after March 18, 2020, for the detection of SARS\u2013CoV\u20132 or the diagnosis of the virus that causes COVID\u201319, are new and involve high throughput machines (which are highly sophisticated equipment) which require more intensive technician training (to ensure the role of extremely skilled personnel) and more time-intensive processes (to assure quality).<\/p>\n

A high throughput technology uses a platform that employs automated processing of more than two hundred specimens a day. Examples of high throughput technology as of April 14, 2020, include but are not limited to technologies marketed on that date as the Roche Cobas 6800 System, Roche Cobas 8800 System, Abbott m2000 System, Hologic Panther Fusion System, GeneXpert Infinity System, and NeuMoDx 288 Molecular. This training and these processes represent an increase in resources, bringing the total resources required for these tests to $100 (a more accurate payment than the one currently in use via contractor pricing). These tests are a type of CDLT currently paid for under Medicare Part B. Specifically, the following codes would identify these tests:<\/p>\n