Update for Health Plans: New Pricing and CPT Code Information
- Net Price (Expected Net Reimbursement): $100 per test, same for all CPT codes
- CPT Codes: 87635, U0003
Effective April 15, 2020, the new pricing for SARS-Cov-2/COVID-19 RT-PCR test using high throughput technologies is $100.00 per test. The pricing adjustment is due to the following:
- Alignment with 100% of CMS reimbursement announced on April 15, 2020.
- High-cost resources required to perform testing on high throughput instruments (which are highly sophisticated equipment), which require more intensive technologist training (to ensure the role of extremely skilled personnel) and more time-intensive processes (to assure quality).
- Continued expansion of high throughput testing capacities to meet extreme demand. The expansion requires the acquisition and development of additional higher cost high throughput testing platforms and infrastructure. Sonic Healthcare USA clinical laboratories currently use four high throughput testing platforms and methodologies and are expanding to eight high throughput testing platforms and methodologies within the next 20 days. The first additional platform is scheduled to go live on April 16, 2020.
- We have experienced over the past few weeks, continuous increases in costs of collection devices, reagents, personal protective equipment (PPE), and shipping and courier fees due to supply chain challenges.
- Clinical and public health reporting requirements to multiple federal and state governmental agencies, and county public health departments require sizeable investments in IT infrastructure and personnel resources.
Sonic Healthcare USA laboratories will honor all health plan amendments for SARS-Cov-2/COVID-19 RT-PCR test executed prior to April 15, 2020. New amendments reflecting current pricing will be offered to health plans with whom we do not currently have an agreement for this test.