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CMS Sets Payment Rate for SARS-CoV-2 Testing

NEW YORK – The Centers for Medicare & Medicaid Services announced Thursday it has set the payment rate for laboratories performing SARS-CoV-2 assays.

Last week, CMS said that labs performing tests developed by the US Centers for Disease Control and Prevention can bill under code U0001. On Thursday, the agency said that those tests will be reimbursed at $35.91 or $35.92 per test. Labs can begin billing for the tests in April for services occurring after Feb. 4, 2020. The CDC assay received Emergency Use Authorization from the US Food and Drug Administration in early February.

Meanwhile, labs using non-CDC tests can bill for the tests using CPT code U0002, and will be reimbursed at between $51.31 and $51.33 per test.  

The reimbursement rate varies slightly depending on region and is subject to the local Medicare Administrative Contractor's decision. Commercial insurers haven't announced their reimbursement rates, but they're expected to align with Medicare's payments.

The federal government has been widely criticized for not having enough testing capacity for SARS-CoV-2. Efforts are underway to improve that and more tests are becoming available. On Friday Roche's Cobas SARS-CoV-2 test received Emergency Use Authorization from the FDA.