Will CMS cover COVID-19 antibody lab tests when performed as part of pre-admission testing/screening for surgical patients?
In its latest COVID-19 interim final rule, CMS-5531-IFC, published on April 30, 2020, CMS announced it would not be creating a National Coverage Determination (NCD) policy for COVID-19 antibody testing. Rather, CMS stated that coverage guidelines for COVID-19 antibody testing would be established through the interim final rule itself. In the rule, CMS states:
“We are finalizing on an interim basis, that during the PHE for the COVID-19 pandemic, Medicare will cover FDA-authorized COVID-19 serology tests as they are reasonable and necessary under section 1862(a)(1)(A) of the Act for beneficiaries with known current or known prior COVID-19 infection or suspected current or suspected past COVID-19 infection. We are amending § 410.32 to reflect this determination of coverage.”
CMS did not provide a list of covered or non-covered diagnosis codes within the rule – and currently there are no diagnosis codes specific to prior COVID-19 infection (either suspected or confirmed).
As the rule did not clearly address how coverage of COVID-19 antibody tests would be determined at the claim level (through covered or non-covered diagnosis codes) it would be our recommendation to reach out to your MAC directly to determine how they plan on implementing the coverage guidelines noted above.
We would also note that CMS is currently accepting comments on CMS-5531-IFC. Comments on the rule, including comments related to the coverage guidelines for COVID-19 antibody testing, can be submitted electronically at the link provided below by clicking the “Comment Now!” button.
Comment on CMS-5531-IFC:
Share the Love!
