Medicare Coverage of COVID-19 Testing for Nursing Home Residents and Patients

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

On Friday, June 19, 2020, CMS instructed Medicare Administrative Contactors and notified Medicare Advantage plans to cover coronavirus disease 2019 (COVID-19) laboratory tests for nursing home residents and patients. This instruction follows the 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 like in an outbreak. Original Medicare and Medicare Advantage plans will cover COVID-19 lab tests consistent with CDC guidance.

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.

Read the Medicare Learning Network article: Medicare Fee-for-Service (FFS) Response to the COVID-19 Public Health Emergency_SE20011 (Revised).

Read the memo to Medicare Advantage plans: Diagnostic Testing of Nursing Home Residents and Patients for COVID-19_June 19, 2020.

More information about Medicare coverage of COVID-19 tests is available at: Coronavirus disease 2019 (COVID-19) tests.