Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
2008
2009
2010
Announcements
Articles
Articles and Publications
Campaign
Case Studies
Charge Capture and Pricing
Coding Integrity
Company
Consulting
Craneware Insights Articles
Education
Home
Journey
News & Events
Opportunities
Other
post
Press Releases
Products
Services
Testimonial
Trade Shows
Uncategorized
Uncategorized
Upcoming Events
Value Cycle
Webinars
White Papers

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:

https://www.regulations.gov/document?D=CMS-2020-0047-0001