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CMS Changes Reimbursement Rates to Accelerate COVID-19 Testing

NEW YORK – The Centers for Medicare and Medicaid Services announced Thursday changes in reimbursement for high-throughput COVID-19 testing performed by laboratories.

Under the new rule, CMS will only pay its highest reimbursement rate, $100 per test, to labs that complete high-throughput testing within two calendar days of specimen collection. For labs that take longer than two days, the reimbursement rate will be $75 per test. The new rate will be effective Jan. 1. High-throughput tests can process at least 200 specimens a day, according to CMS' original payment rule. 

The base payment amount for COVID-19 testing will now be $75, with a $25 add-on payment for labs performing high-throughput testing if that specific test is performed within the time limit and if the lab has completed the majority of its high-throughput testing in two days or less for all patients, not just Medicare beneficiaries, in the previous month, CMS said.

The move is an attempt by CMS to support faster high-throughput diagnostic testing for SARS-CoV-2, the agency said. In April, CMS raised the payment rate for high-throughput COVID-19 tests from $51 to $100.

In response to the CMS announcement, the American Clinical Laboratory Association released a statement saying the payment decrease won't address "the root causes of delayed turnaround times," which the organization cited mainly as fluctuations in demand and access to necessary supplies. ACLA President Julie Khani added that the policy could create a "domino effect where patient access to testing is severely reduced."

In an analyst note, Vijay Kumar from Evercore ISI said he expects the added incentive will push labs to expand capacity as they work to avoid payment cuts.