What The End of The PHE Means for Laboratory Providers

With the announcement from President Biden that his administration plans to end the COVID-19 Public Health Emergency (PHE) on May 11, 2023, many diagnostic providers are wondering how they will be impacted. CMS has published several provider-specific fact sheets about the PHE waivers and flexibilities, including which have been terminated, have been made permanent or will expire at the end of the PHE. 

Key highlights from the CMS Laboratories: CMS Flexibilities to Fight COVID-19 Fact Sheet include:  

• High-Throughput Testing Reimbursement: When the PHE ends, HCPCS codes U0003, U0004, U0005 will no longer be payable. Rates for high-throughput testing will be reduced from $75 to $51. The $25 add-on charge for completed testing within two days will be eliminated. Private payors may also discount their COVID-19 reimbursement rates below the new Medicare rates.
• Out-of-Network Testing: Commercial health plans will no longer be required to reimburse out-of-network labs for COVID-19 tests based on their listed cash charge.
• Costing Sharing or Prior Authorization: Private commercial health plans will no longer be required to provide COVID-19 testing or vaccines without cost-sharing, prior authorization, or other medical management requirements.
• Referring Physician Requirement to Test: Medicare will require all COVID and related testing performed by a laboratory to be ordered by a physician or non-physician practitioner.
• Price Transparency: Providers will no longer be required to make the cash price for COVID testing public on their website.
• Specimen Collection: HCPCS codes for independent labs – $23.46 for specimen collection (G2023) and $25.46 for specimen collection from nursing-home patients (G2024) – will no longer be payable.
• Waivers on Certain Stark Laws: Any waivers relating to physician self-referral laws (Stark Laws) will expire.

For additional information visit the CMS Coronavirus waivers and flexibilities website.  To stay up to date on issues impacting reimbursement subscribe to the XiFin Blog.