Dive Brief:

• The American Clinical Laboratory Association has warned that “inadequate payment rates” may affect access to monkeypox testing.
• In recent days, the ACLA has learned that Medicare Administrative Contractors have set rates ranging from $35.09 to $51.31, fees that the trade group said “do not account for the inputs required to run a monkeypox test.”
• The association responded by urging the Centers for Medicare & Medicaid Services to tell claims processors to pay monkeypox testing claims “at the reasonably derived ACLA recommended rate” to ensure access to testing.

Dive Insight:

The ACLA, the trade group representing leading clinical laboratories, set out its thoughts on coding, payment and coverage for monkeypox testing in a letter to the CMS late last month. The letter put ACLA’s recommended payment rate for monkeypox testing at $76.97, a figure it calculated by applying a 1.5 multiplier to the Zika virus fee to take into account extra resources such as personal protective equipment and the use of a Biosafety Level-3 facility.

While the trade group was waiting for a formal response, MACs including First Coast Services Options and Novitas set their rates at $51.31. The ACLA also said it learned via email that Noridian, which processes Medicare claims for all of California, has set its rate at $35.09.

“Both of these rates do not align with ACLA’s recommendations and do not account for the inputs required to run a monkeypox test. This raises significant concerns that an inadequate payment rate may impact patient access to testing for a pathogen that is currently declared a public health emergency in the United States,” the trade group wrote in its letter to the CMS.

The ACLA expressed concerns that the payment rate may have an impact on access to testing now and in the future by both its members and other healthcare groups. The trade association contrasted the situation unfavorably to the response to COVID-19, when it said “adequate reimbursement” enabled the scale up of testing. 

In light of the concerns, the ACLA has urged the CMS to “instruct MACs, through a CMS Ruling or other mechanism, to pay claims for monkeypox testing at the reasonably derived ACLA recommended rate to support sufficient testing capacity and patient access.” The trade group wrote that it also wants Medicare to support “appropriate coverage, payment, and billing policies consistent with the standard of care.”