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AMP, CAP, Others Request Medicare Coverage for Respiratory Panel Tests

NEW YORK – Six medical organizations, including the College of American Pathologists and the Association for Molecular Pathology, submitted a letter to the Centers for Medicare and Medicaid Services on Tuesday advocating for national coverage for multiplex respiratory viral panel tests.

Laboratories are facing increased requests for these PCR tests during the SARS-CoV-2 pandemic to rule out patients with other viral respiratory conditions and to guide treatment, the letter said. Medicare coverage of these tests is limited, with current local coverage determinations for the panels limited to three to five pathogens and to immunocompromised patients only. In 2018, Medicare Administrative Contractor Palmetto GBA denied coverage of large respiratory panels as frontline diagnostics. 

However, the US Centers for Disease Control and Prevention has encouraged physicians to test patients for other infections causing respiratory illnesses, and CMS released guidance clarifying that alternate testing should be covered to help determine the need for SARS-CoV-2 diagnostic testing.

The tests detect influenza, parainfluenza, respiratory syncytial virus, metapneumovirus, adenovirus, and several common coronaviruses and can improve turnaround times for patients under investigation. Using these tests can preserve personal protective equipment for healthcare workers and help with assigning appropriate care to patients, the letter said. Respiratory viral panel tests are particularly important in areas with limited access to SARS-CoV-2 tests and supplies, the organizations added. They can also provide information on the likelihood of co-infections.

The letter also noted the possibility of SARS-CoV-2 reemerging after this original outbreak and emphasized the need for laboratories to be appropriately reimbursed to continue providing alternate testing. "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 letter said.