Laboratories and Other Providers Must Follow Mandatory Assignment Regulations for COVID-19 Tests and Test Kits

COVID-19 tests and test kits are paid at 100% of Medicare’s allowable with no patient cost-sharing. Claims for COVID-19 clinical diagnostic laboratory tests or test kits submitted by Medicare-enrolled laboratories or providers/suppliers are paid on an assignment-related basis as required by section 1833(h)(5)(C) of the Social Security Act (the Act). When a claim is assigned, Medicare’s payment is made directly to the Medicare-enrolled provider. Assignment for these services requires that providers/suppliers accept Medicare’s payment as payment in full.

If a beneficiary bills Medicare and receives payment for a COVID-19 test or test kit, providers/suppliers are prohibited by section 1833(h)(5)(D) of the Act from attempting to bill the beneficiary more than the Medicare-approved amount. Providers/suppliers that collected amounts that exceed the Medicare-approved amount must refund the excessive amounts. Failure to refund the entire amount is an assignment violation.

If a laboratory or provider/supplier is attempting to bill or has already collected more than the Medicare-approved amount for COVID-19 clinical diagnostic laboratory tests or the test kits, it may be subject to civil monetary penalties, additional monetary assessments, and exclusion from the Medicare program when continuing to pursue or refusing to refund beneficiaries for those excessive amounts.

Reminder: The PHE ended on May 11, 2023, so the program that provided eight test kits/month at no cost to the beneficiary ended on this date.

 

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