Does Medicare Cover PCR Testing and What You Need to Know

Medicare covers PCR testing for COVID-19, but there are some conditions. Medicare Part B covers PCR testing if you have a doctor's order for the test.

If you're a Medicare beneficiary, you won't have to pay out-of-pocket for the test. However, you may be responsible for copays and coinsurance for the test.

The Centers for Medicare and Medicaid Services (CMS) allows Medicare to cover PCR testing for COVID-19. This means that Medicare will cover the test, but you'll still need to follow the doctor's order and meet other requirements.

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Original Medicare generally doesn't cover the cost of at-home COVID-19 tests. Some Medicare Advantage plans and private health plans may cover them, or you can use FSA or Medicare OTC cards to pay for the tests.

The price of an over-the-counter kit can vary, but is generally less than $5 each. There are also over 30 brands of over-the-counter tests to choose from.

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Medicare Part B covers COVID-19 diagnostic lab tests when ordered by a healthcare provider and performed in a lab. You usually don't need to pay the Part B deductible or any coinsurance for these tests.

Medicare covers diagnostic lab tests for COVID-19 and many other diseases and conditions, but there are limits to what it will cover. Routine or screening lab tests that are not medically necessary, cosmetic or experimental tests, and tests for non-Medicare covered conditions are not covered.

Here's a breakdown of what Medicare covers:

However, Medicare doesn't cover:

Medicare beneficiaries can get rapid antigen or PCR diagnostic tests without paying anything out of pocket if the test is ordered by a doctor or other healthcare provider and performed by a lab.

To get a lab COVID-19 test with Original Medicare, you must show symptoms of COVID-19 and be a Medicare beneficiary. To qualify for Medicare, you must be 65 or older or younger and receiving Social Security Disability Insurance (SSDI) or living with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

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The cost of a lab test for COVID-19 with Medicare varies depending on your plan. If you're in the hospital, Part A will cover the test if you've met the $1,676 deductible. Most people don't pay a premium for Part A.

In 2025, after meeting the annual Part B deductible of $257, Part B will cover 80% of any covered treatment or service, including laboratory tests. You'll also pay a monthly premium, which starts at $185, depending on your income.

Here's a breakdown of the costs:

Keep in mind that private insurers manage Medicare Advantage plans, and their premiums, deductibles, and coinsurance vary depending on the specific plan.

At-Home Testing can be a convenient option for Medicare beneficiaries.

Medicare covers at-home COVID-19 tests, but only for those who are eligible for the program.

Medicare will cover up to eight at-home COVID-19 tests per month for each person on the plan.

You can purchase at-home tests from a pharmacy or online retailer that accepts Medicare.

Medicare will reimburse you for the cost of the test, but you'll need to submit a claim for reimbursement.

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You won't have to pay Medicare Part D deductibles and copays for Covid-19 diagnostic lab tests, as Medicare Part B typically covers them when ordered by a healthcare provider.

Generally, you don't need to pay the Part B deductible or any coinsurance for these tests.

Medicare Part D is not involved in coverage for Covid tests.

Medicare has some limits to what it will cover, including routine or screening lab tests that are not medically necessary, cosmetic or experimental tests, and tests for Non-Medicare covered conditions, such as some elective procedures.

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PCR testing is an important tool in diagnosing COVID-19, and Medicare has specific guidelines on coverage.

Medicare beneficiaries can get rapid antigen or PCR diagnostic tests without paying anything out of pocket if the test is ordered by a doctor or other healthcare provider and performed by a lab. This is a great benefit for those who need to get tested.

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PCR tests will not be covered when the test is read/processed in an office setting. Instead, they need to be sent to a clinical laboratory for processing.

The CPT code for lab processing can include: 87635, 87636, 87637, 0202U, 0223U, 0225U, 0240U, 0241U, U0001, and U0002. These codes are essential for lab facilities to submit claims correctly.

Professional providers will not receive reimbursement for the lab processing, which is an important thing to note.

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Medicare covers COVID-19 tests when conducted in laboratories, but not at-home test kits since 2023.

In 2025, after meeting the annual Part B deductible of $257, Medicare will cover 80% of covered laboratory tests, including COVID-19 tests.

You can get free at-home COVID tests through the COVIDtests.gov website, where you can order four tests per residence.

The Biden administration is also providing up to 50 million additional free at-home tests to community health centers and Medicare-certified health clinics.

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To get free at-home tests from community health centers or Medicare-certified health clinics, you'll need to check with them directly.

Medicare beneficiaries in Medicare Advantage managed-care plans may also be eligible for free at-home tests, but it depends on the specific plan.

Here are some key costs to keep in mind:

In 2025, after meeting the Part B deductible, Medicare will cover 80% of covered laboratory tests, including COVID-19 tests.