covid testing FAQs

With so many changes continually taking place in the healthcare system around the COVID-19 pandemic, it’s become critical that providers stay fully informed about updated Medicare coverage and pricing. Because Medicare patients are typically 65 years of age or older – or are younger adults with serious underlying diseases – they are considered “highest risk” for COVID-19. With currently hundreds of thousands of Medicare patients seeking testing and treatment for the virus, here’s a brief FAQ to get up to speed about Medicare guidelines as related to COVID-19:

Q. Are COVID-19 tests covered by Medicare?

A. COVID-19 testing is fully covered under Medicare Part B, in accordance with new rules announced on April 30, 2020, stating that an order from a physician is no longer required to receive a COVID-19 test under Medicare. Therefore, anyone under Medicare can receive a COVID-19 test at a community testing facility, such as a drive-thru testing site. Additionally, Medicare covers serology tests that are used to detect infection of SARS-CoV-2, as well as antibodies to the COVID-19 virus.

Q. How much do Medicare beneficiaries pay for testing?

A. Under current policy guidelines, Medicare beneficiaries are not required to pay the Part B deductible for COVID-19 testing or serology testing, as these are considered diagnostic laboratory tests. The Families First Coronavirus Response Act also prohibits beneficiary cost-sharing for any COVID-19 related testing, including tests performed by a physician or an outpatient facility.

Q. Does Medicare cover treatment for COVID-19?

A. In many cases, people affected by COVID-19 can become seriously ill, requiring extensive inpatient or outpatient services. Under Part A, Medicare covers all inpatient hospital stays, some home health visits, and hospice care. Under Part B, Medicare covers related outpatient services, such as physician visits or emergency room visits. In the event that inpatient hospitalization is needed, treatment will be covered for all Medicare beneficiaries.

Because Medicare payment and coverage policies will continue to evolve, it’s important that your healthcare facility remains vigilant in educating administrative and coding staff about new changes.

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