Are you experiencing underpayments on COVID-19 rapid antigen tests?

March 11, 2021

The California Medical Association (CMA) has received several reports from practices very concerned that commercial payors are shifting the financial risk of critical COVID-19 diagnostic testing to physicians on the front lines by reimbursing far below the cost of the test itself. CMA has asked the California Department of Managed Care (DMHC) and the California Department of Insurance (CDI) to investigate these concerns as this practice appears to be inconsistent with DMHC’s emergency regulations and CDI's guidance on COVID-19 diagnostic testing, as well as the federal Coronavirus Aid, Relief and Economic Securities (CARES) Act.

The issue is specific to reimbursement of COVID-19 rapid antigen tests. These inexpensive tests are used at the point of care and return a result within approximately 15 minutes. Each rapid antigen test kit costs physicians approximately $35-$40. However, CMA has heard from several physicians that Anthem and United Healthcare are reimbursing less than half of the physicians’ cost.

When payors shift the financial responsibility for COVID-19 testing to physicians, it becomes financially untenable for practices to utilize the rapid test for their patients. Ensuring physicians can administer rapid antigen tests is critical, particularly when experts are calling for more rapid tests to allow for the reopening of the economy and schools.

CMA has urged regulators to formally investigate and take appropriate action to ensure payors are not impeding patients’ access to appropriate and necessary COVID-19 testing in violation of state and federal law and profiting at the expense of treating physicians.

If you have experienced underpayment of COVID-19 rapid antigen tests, CMA wants to hear from you. Please contact CMA's Reimbursement Helpline at (888) 401-5911 or economicservices@cmadocs.org.


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