Charges of COVID-19 Diagnostic Testing and Antibody Testing Across Facility Types and States
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J Gen Intern Med DOI: 10.1007/s11606-020-06198-y © Society of General Internal Medicine 2020
INTRODUCTION
The high charges for COVID-19 testing by some healthcare providers have received broad media and public attention.1 Individual providers determine their own charge, which does not vary with insurance type.2, 3 The charges for COVID-19 testing have important implications for out-of-network plans, uninsured patients, and other payers with little negotiating power. The CARES Act requires that private plans that do not have a negotiated rate with the provider pay the price publicly listed by the provider for COVID-19 testing, which is usually the same as or a percentage of the charge.4, 5 Providers that have tested uninsured patients can choose to either seek reimbursement from the Department of Health and Human Services or bill uninsured patients at a self-determined price, which equals the charge unless the provider offers a discount. Therefore, the higher the charge for COVID19 testing, the higher the potential cost exposure of plans without negotiating power and of uninsured patients. Nationwide COVID-19 testing charges across facility types remain unexplored. In this study, we aim to examine the charges for the most commonly performed COVID-19 diagnostic test (CPT code: 87635) and antibody test (CPT code: 86769) across facility types and states.
METHODS
We obtained administrative claims data for COVID-19 testing from the COVID-19 Research Database, a pro bono cross-industry collaborative.6 The sample consisted of 182,149 claims of diagnostic testing (CPT code: 87635, Medicare rate $51.31) from 2324 providers in 50 states and DC, and 318,546 claims of antibody testing (CPT code: 86769, Medicare rate $42.13) from 764 providers in 46 states and DC. All claims were submitted between March 19 and July 19, 2020. We obtained the state-level diagnostic testing rate, infection Received August 1, 2020 Accepted August 27, 2020
rate, and mortality rate, as of July 20, 2020, from the Johns Hopkins Coronavirus Resource Center. For each test and facility type, we calculated the average charge (total charges divided by total claims and compared across facility types). For each test and state (with more than ten claims), we calculated the average charge and grouped the states into low, medium, and high tertiles. We analyzed the correlation between each state’s average testing charge and its COVID-19 testing rate (available only for diagnostic testing), infection rate, and mortality rate to understand whether the testing charges were influenced by the demand for the test.
RESULTS
For COVID-19 diagnostic testing, the mean, median, and standard deviations of charges were $144.06, $100.00 (IQR $67.00–$155.00), and $162.18. The most common facility type was independent laboratories (performed 49.7% of all tests), with an average charge of $140.41 (range $0.01–$14,750.00, IQR $67.00–$100.00), followed by hospital outpatient settings (performed 34.5% of all tests), with an average charge of $168.87 (range $0.01–$2436.00, IQR $
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