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Medicare Part B Payments for Over-the-Counter COVID-19 Tests During the PHE Demonstration

Announced on  | Last Modified on  | Project Number: A-06-23-06000
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

On April 4, 2022, CMS launched the Medicare Over-the-Counter COVID-19 Test (OTC test) Demonstration (Demonstration) to cover and pay for OTC tests for people with Medicare Part B benefits, including people enrolled in Medicare Advantage plans (enrollee), for the remainder of the COVID-19 Public Health Emergency. During the Demonstration period, Medicare covered for each enrollee up to eight OTC tests per calendar month. If an enrollee received more than eight OTC tests in a calendar month, the enrollee may have had to pay out-of-pocket costs for the extra tests unless the enrollee had additional health coverage. We will determine whether Medicare paid eligible pharmacies and health care providers for OTC tests according to the Demonstration.

TIMELINE

  • August 16, 2023
    Announced
  • February 19, 2025
    Complete

    Medicare Part B Payments for Over-the-Counter COVID-19 Tests During the PHE Demonstration has been marked as complete. This audit resulted in 1 recommendation.

REPORT PUBLISHED

Medicare Paid Claims That Were Not in Accordance With the Over-the- Counter COVID-19 Test Kits Demonstration Quantity Limitation (A-06-23-06000)

25-A-06-046.01 to CMS - Closed Implemented
Closed on 04/24/2025
We recommend that, for items or services for which the Medicare program establishes a quantity limit, CMS use the results of this audit to research and determine the best method(s) (e.g., nationwide system edits, information-sharing between providers, and other mechanisms) to detect and prevent improper payments to providers.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
COVID-19 Financial Stewardship Medical Supplies and Equipment
Target Groups
-
Financial Groups
Medicare B