Has CMS issued new guidance clarifying insurance coverage of COVID-19 tests for asymptomatic patients?
Yes. On February 26, 2021, CMS issued a new documented entitled, “FAQs Part 44”, which further clarifies when group health plans are required to cover COVID-19 diagnostic tests with no cost share responsibility for their beneficiaries. Per the updated guidance, group health plans cannot use medical screening criteria to deny coverage of COVID-19 tests for asymptomatic beneficiaries with no known recent exposure to COVID-19. A specific example provided by CMS:
“For example, covered individuals wanting to ensure they are COVID-19 negative prior to visiting a family member would be able to be tested without paying cost sharing.”
The updated CMS guidance also clarifies that group health plans must cover point-of-care COVID tests as well as COVID tests administered at state or locally run testing sites.
In addition, the new documentation also highlights the existing avenues available for providers to seek federal reimbursement for costs related to COVID-19 diagnostic testing and vaccine administration for uninsured patients; for example, the Provider Relief Fund program as well as the HRSA COVID-19 Uninsured Program.
We would strongly encourage all providers to closely monitor their claims for COVID-19 testing related services to ensure commercial payers are adhering to these new coverage guidelines.
CMS FAQs Part 44:
CMS Press Release, “Biden Administration Strengthens Requirements that Plans and Issuers Cover COVID-19 Diagnostic Testing Without Cost Sharing and Ensures Providers are Reimbursed for Administering COVID-19 Vaccines to Uninsured”: