Sunday, January 31, 2021

Very Brief Blog: CMS Updates Webpage for MAC COVID Test Pricing

CMS has periodically published MAC prices for the rapidly appearing range of COVID lab test codes.  This will be equally important in 2021, because CMS bumped a number of the codes into the "gapfill" process rather than directly assigning national prices.

Good news for CMS watchers - CMS updated its webpage for MAC COVID prices on January 25, 2021. 

  • Find the current CMS price list here.
  • I've put a duplicate copy in the cloud here.

I've clipped the table below as well.  The MAC prices are uniform so you really only need the first 3 columns.

click to enlarge

Among the more common tests, the standard AMA CPT PCR test (not high throughput) is 87635 $51.  The antigen test 87426 is $35.   The single step antibody test is 86328 $45, the multi step (e.g. Elisa) is 86769 $42.  The "gold standard" neutralizing antibody tests are screening, 86408 $42, and titer, 86409 $80.  CMS bumps up to $142 for combination tests, e.g. COVID + FLU.  

CMS has fixed prices for U-series codes for high throughput PCR testing, $75, and CMS adds $25 via an add-on code if reported in two days. (Trade article here).  (See also, interview with ACLA, here.)

For an August 2020 blog on COVID test coding, Lennerz, Link In, here.