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CMS Announces Upcoming Changes to COVID-19 Test Reimbursement Policies

NEW YORK — With the upcoming end of the COVID-19 public health emergency (PHE), the US Centers for Medicare & Medicaid on Monday announced planned changes to how it will reimburse for SARS-CoV-2 tests.

Once the PHE expires on May 11, CMS will no longer provide blanket coverage for the cost of over-the-counter COVID-19 tests, the agency said. Those enrolled in Medicare Part B will continue to have coverage with no out-of-pocket expenses for appropriate lab-based COVID-19 PCR and antigen tests, however, when a healthcare provider orders these tests.

Those enrolled in Medicaid or the Children's Health Insurance Program will continue to have access to COVID-19 over-the-counter and lab testing through the end of September, CMS said. After then, coverage may vary by state.

Private insurance plans, CMS noted, are not required by federal law to cover COVID-19 testing after May 11. If a private payor chooses to cover COVID-19 testing, they may require cost sharing, prior authorization, or other forms of medical management, CMS said.

CMS's updated reimbursement policies for COVID-19 tests have been expected, with clinical labs bracing themselves for the effects on their testing businesses. Legislators have also been weighing the expected impact of the new policies; last month, a group of Democratic senators issued a letter to the US Department of Health and Human Services asking for continued coverage of at-home COVID-19 tests for Medicare beneficiaries.

The US Food and Drug Administration, meantime, recently released guidance for COVID-19 device developers on how to transition from Emergency Use Authorization to full marketing and regulatory authorization for their testing products.