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Antibody Testing Reimbursement

How antibody testing can bolster your lab’s revenue stream

With Covid-19 diagnostic testing numbers declining throughout the country as vaccines proliferate, and the Center for Disease Control recommending vaccinated individuals skip testing, now is a good time for labs that have been engaged in this line of business to consider alternatives to bolster their revenue stream moving forward.

One emerging alternative is testing for the presence of neutralizing antibodies in vaccinated individuals or those who have previously had Covid-19 through the use of titers. A titer is a laboratory test that measures the presence and number of antibodies in blood. A titer may be used to prove immunity to disease, such as Covid-19.

MORE: Understanding neutralizing antibody testing.

As we go forward into the fall and approach the next flu season, people are going to have concerns about different variations of Covid and their overall immunity levels,” says Mick Raich, President of RCM Consulting for Lighthouse Lab Services. “Given that reality, antibody testing is a classic way to provide peace of mind for people, while also creating an avenue for labs to continue to generate revenue moving forward.

 

Pricing for these tests

Due to the relatively recent emergence of these tests, most are not currently listed on the Medicare Physician or Clinical Lab Fee Schedules. Instead, titers are currently priced by individual Medicare Administrative Contractors (MACs). For example:

  • 0224U – Traditional Antibody Titer = $42.13 (All MACs)
  • 86409 – Neutralizing Antibody SarsCov2 Titer = $79.61 to $105.33 (Depending on MAC)

While the FDA has previously issued Emergency Use Authorizations (EUAs) to more than 50 antibody (serology) tests, those tests only detect the presence of binding antibodies. Binding antibodies bind to a pathogen, such as a virus, but do not necessarily decrease the infection and destruction of cells. As you can see below, pricing for these tests is fairly consistent across MACs:

  • 86769 – Traditional Antibody Test = $42.13 (All MACs)
  • 86408 – Neutralizing Antibody SarsCov2 Screen = $42.13 (All MACs)
  • 86413 – Quantitative Antibody Test = $42.13 to $51.43 (Depending on MAC)

 

Validation and referencing costs

Lighthouse is available to assist you if you have interest in validating these tests for your laboratory. The total cost is about $62,000 for equipment, validation supplies, and clinical validation consulting.

Additionally, we can also help with the process of referencing this type of testing out to another lab. For example, META Lab Dx is offering lab-to-lab reference work for $28/test for Quantitative Antibody Testing and $48/test for Covid Titer testing.

As the country continues to open back up, these tests can help folks understand the level of individual precaution they need to be taking,” says Raich. “This is a great way to provide peace of mind while boosting your revenue stream at the same time.

 


 

Lighthouse Lab Services offers assistance to the clinical lab industry via Lab Management, Recruiting, LIS, Consulting, and Lab Director Services. Please, feel free to reach out to us if your lab needs any help.

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