Laboratory Question for the Week of November 15, 2021

Question:

I’ve heard that CMS changed payment for high throughput testing, is this true? If yes, how so?

Answer:

With the addition of HCPCS U0005, CMS announced that it would be amending the payment rate for “high throughput” testing beginning January 1, 2021. As of this date, Medicare is paying $100.00 only to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen collection. For laboratories that take longer than two days to complete these tests, Medicare will pay a rate of $75.00. This change was based upon the amended administrative ruling, CMS 2020-1-R2. This payment modification will be implemented by decreasing the reimbursement amount for HCPCS codes U0003 and U0004 from $100.00 to $75.00 and establishing a new add-on payment of $25.00 for HCPCS code U0005. Laboratories billing Medicare for the add-on payment must meet all the requirements established in the code descriptor and the CMS Ruling.

This question was answered in an edition of our Laboratory Compliance Manager. For more hot topics relating to laboratory services, please visit our store or call us at 1.800.252.1578, ext. 2.