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Medicare Coverage for COVID-19 Testing in Nursing Homes

The Centers for Medicare and Medicaid Services (CMS) has instructed Medicare Administrative Contractors (see Medicare Learning Network article SE20011, page 9) and notified Medicare Advantage plans that they are to cover COVID-19 laboratory tests for nursing home residents and patients.

This instruction follows the Centers for Disease Control and Prevention’s (CDC) recent update of COVID-19 testing guidelines for nursing homes that provides recommendations for testing of nursing home residents and patients with symptoms consistent with COVID-19, as well as for asymptomatic residents and patients who have been exposed to COVID-19, such as in an outbreak. Original Medicare and Medicare Advantage plans will cover COVID-19 lab tests consistent with CDC guidance.

Starting on July 6, 2020, and through the duration of the public health emergency, consistent with the aforementioned CDC guidelines, original Medicare and Medicare Advantage plans will cover diagnostic COVID-19 lab tests as follows:

  • Viral testing of residents for SARS-CoV-2;
  • Initial viral testing in response to an outbreak;
  • Recommended testing to determine resolution of infection with SARS-CoV-2; and
  • Public health surveillance for SARS-CoV-2.

Tests that are considered non-diagnostic are not covered.

Medicare Advantage plans must continue not to charge cost sharing (including deductibles, copayments, and coinsurance) or apply prior authorization or other utilization management requirements for COVID-19 tests and testing-related services.

More information about Medicare coverage of COVID-19 tests is available on the Medicare.gov website.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866