Charges of COVID-19 Diagnostic Testing and Antibody Testing Across Facility Types and States

Abstract

The high charges for COVID-19 testing by some healthcare providers have received broad media and public attention. These charges 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. 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. We find that a small proportion of COVID-19 diagnostic testing and antibody testing services, provided in selected states, had charges that far exceeded the Medicare rate. High charges may create financial barriers for some uninsured patients and lead to higher premiums for out-of-network private plans. The results, based on a proportion of all testing claims in the USA, might underestimate the national variation of COVID-19 testing charges. The insurance and network status of each claim and the actual prices paid were unavailable.