CMS expands coverage of coronavirus testing, includes serology

2020 04 30 21 13 0442 Medicare Puzzle 400

The U.S. Centers for Medicare and Medicaid Services (CMS) said it has made additional policy changes during the pandemic that will support and expand coverage of novel coronavirus testing for beneficiaries.

The changes reflect input from healthcare providers, as well as the provisions of the recently passed federal Coronavirus Aid, Relief, and Economic Security (CARES) Act, CMS explained. They include a loosening of requirements for requesting tests for the novel coronavirus and other laboratory tests required to make a diagnosis of COVID-19, the respiratory illness caused by SARS-CoV-2. Medicare coverage will be provided for tests requested by any healthcare professional authorized under state law, with no need for a written order, as part of emergency policy during the pandemic.

"Testing is vital, and CMS's changes will make getting tested easier and more accessible for Medicare and Medicaid beneficiaries," CMS Administrator Seema Verma said in a statement detailing the changes.

CMS will also cover certain antibody tests, which are used to gauge immune response following exposure, as well as lab processing of FDA-authorized self-collection tests.

The announcement followed on the heels of a request for CMS to expand national coverage of testing in a letter from major healthcare organizations, including the College of American Pathologists and the Association of Public Health Laboratories.

In a letter to Verma on April 28, the healthcare organizations said the need for multiplex polymerase chain reaction (PCR) respiratory viral panel (RVP) testing coverage is vital amid an "exponential increase" in requests by clinicians. The tests are a critical part of triaging patients with confirmed or suspected cases of COVID-19 and other viral respiratory conditions.

"Unfortunately, laboratories are currently absorbing the cost of performing these tests, which are critical to preventing transmission and speeding recovery during this national emergency," the letter stated.

Local coverage for RVPs is currently restricted to three to five pathogens and only in immunocompromised patients. The limited coverage contradicts new recommendations from the U.S. Centers for Disease Control and Prevention and CMS encouraging clinicians to test for pneumonia, influenza, and other respiratory illness.

"The very limited Medicare coverage in the face of the critical demand for tests is contributing to the significant financial burden on laboratories and pathologists as a result of the COVID-19 pandemic," the organizations wrote.

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