New Guidelines for Pharmacy COVID-19 Testing and Billing from CMS

Kevin Lathrop

Kevin Lathrop About The Author

May 12, 2020 2:50:55 PM

The Centers for Medicare and Medicaid Services (CMS) announced that Medicare pharmacies can temporarily enroll as independent clinical diagnostic laboratories. The announcement, released on May 7, 2020, enables pharmacies that are enrolled in Medicare to test for COVID-19 and bill through Medicare. For independent pharmacies interested in conducting COVID-19 testing, this announcement comes as a welcome update.

On April 8, 2020, the Department of Health and Human Services authorized pharmacists to orderCOVID-19 Test Tube and administer COVID-19 tests. Since that update, TDS prioritized enabling our pharmacists to administer and bill for COVID-19 testing. We have been working directly with regulatory agencies and to provide the tools pharmacists need during this time.

The official guidelines released from CMS provide initial guidance on how to bill COVID-19 tests via Medicare Part B. If a pharmacist already has a CLIA waiver and is enrolled to bill Medicare, they can be fast-tracked to bill for COVID-19 testing. Independent pharmacies can provide valuable resources to help combat the coronavirus pandemic and increase testing capabilities for COVID-19. NCPA also released an instructional webinar, helping pharmacists prepare for testing  and billing through Medicare. Unfortunately, COVID billing via commercial health plans is still unclear at this time.

For Medicare-enrolled pharmacies, the temporary billing privileges for an independent clinical diagnostic laboratory can be initiated by calling the provider enrollment hotline. Your Medicare Administrative Contractor (MAC) office will collect the necessary information from you over the phone and provide an email update on your temporary Medicare billing privileges, including an effective date.  Have the following information ready when contacting the hotline:

  • Legal business name
  • National provider identifier (NPI)
  • Tax identification number (TIN)
  • State license
  • CLIA certificate number
  • Address information
  • Contact information and phone number

After the initial phone call, requests should be answered within two business days. An end date has not been released yet for the temporary Medicare billing privileges. If a pharmacy is not currently enrolled in Medicare, they can enroll as an Independent Clinical Diagnostic Laboratory by submitting a CMS-855B enrollment application to the MAC in their area.

Read the full article from CMS here.