Claims Must be Filed for Covered COVID-19 Tests

When a CLIA-approved laboratory furnishes a service payable under Part B, including a COVID-19 clinical diagnostic laboratory test, the provider/supplier is subject to the mandatory claim submission provisions of section 1848(g)(4) of the Act. Therefore, if a provider/supplier charges or attempts to charge a beneficiary any remuneration for a service payable under Part B, the provider/supplier must submit a claim to Medicare. Violators of the mandatory claim submission rules may receive civil monetary penalties and exclusion from the Medicare program (see section 1848(g)(4)(B) of the Act).

During the PHE for COVID-19, Medicare covered a beneficiary’s first COVID-19 clinical diagnostic laboratory test without an order. Subsequent tests during the PHE required a physician’s or other practitioner order.

In addition, COVID-19 clinical diagnostic laboratory tests were only covered during the PHE when performed for the purpose of diagnosing known or suspected infection or exposure to COVID-19. Tests performed for travel or other non-covered purposes are not covered.

When filing claims for which the beneficiary has paid for covered services up front, the beneficiary paid amount must be entered in Item 29 on the CMS 1500 claim form or the electronic claim equivalent.


Last Updated Jul 18 , 2023