CMS expands coverage for essential diagnostic services amid COVID-19 pandemic

U.S. Dept. of Health & Human Services, Washington, D.C., Ralf Roletschek via <a href="">Wikimedia Commons</a>U.S. Dept. of Health & Human Services, Washington, D.C., Ralf Roletschek via Wikimedia Commons

The Centers for Medicare and Medicaid Services, along with the Departments of Labor and the Treasury, have issued guidance aimed at ensuring Americans with private health insurance have coverage of COVID-19 diagnostic testing and certain other related services, including antibody testing, at no cost.

As part of the effort to slow the spread of the virus, this guidance is meant to remove financial barriers for Americans to receive necessary COVID-19 tests and health services, and to encourage the use of antibody testing that may help to enable healthcare workers and others get back to work more quickly.


The announcement implements the requirement for group health plans and group and individual health insurance to cover both diagnostic testing and certain related items and services provided during a medical visit with no cost-sharing. This includes urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office that result in an order for or administration of a COVID-19 test.

Covered COVID-19 tests include all FDA-authorized diagnostic tests, diagnostic tests that developers request authorization for on an emergency basis, and diagnostic tests developed in and authorized by states. It also ensures that COVID-19 antibody testing will also be covered. Once broadly available, an antibody test could become a key element in fighting the pandemic by providing a more accurate measure of how many people have been infected.


This action, and earlier CMS actions in response to COVID-19, are part of ongoing White House Coronavirus Task Force efforts.

In March, representatives of major health insurance companies met with President Trump, where they voluntarily committed to covering COVID-19 testing without cost-sharing such as copays and coinsurance.

Building on that commitment, the guidance implements the recently enacted Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act, which require that private health issuers and employer group health plans cover COVID-19 testing and certain related items and services furnished during the COVID-19 pandemic, with no out-of-pocket expenses.

The latest action by CMS follows a series of updated guidance documents the agency issued last week that focused on infection control to prevent the coronavirus’ spread. That guidance, based on Centers for Disease Control and Prevention guidelines, is designed to ensure infection control in the context of patient triage, screening and treatment, the use of alternate testing-and-treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning-and-disinfection guidelines, staffing, and more.


“It is critical that Americans have peace of mind knowing that cost won’t be a barrier to testing during this national public health emergency,” said Administrator Seema Verma. “(Saturday’s) action under the leadership of President Trump allows millions of Americans to access the vital health services they need to fight COVID-19, including antibody testing once it becomes widely available.”

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