The most recent report on sexual health from the Centers for Disease Control and Prevention (CDC) points to an STI epidemic with “no signs” of abating. Syphilis rates surged, increasing nearly 32% in 2021, while gonorrhea and chlamydia increased around 4%. Many patients impacted are members of “groups more likely to face social conditions that make it more difficult to stay healthy,” such as Black/African American and American Indian/Alaska Native people. In related data, men’s condom use was down from 75% in 2011 to 42% in 2021.
The CDC calls for increased access to sexual health services and prioritization of STI screening and treatment, an all-hands attempt to turn the surge. So why hasn’t the American Medical Association (AMA), which approved CPT codes for a Covid-19 lab test as early as March 2020, approved CPT codes for at-home STI testing and linkage to care services?
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At-home diagnostic testing allows providers and digital health companies to screen for contagious diseases, certain cancers, allergies, and STIs by mailing test kit materials home. The patient deposits samples on dried blood spot cards, swabs, and other self-collection materials and submits them to a lab to be resulted. Fourteen billion laboratory tests are ordered annually, and many Americans have already successfully used an at-home diagnostic test — a PCR Covid-19 test.
Indeed, telemedicine in the United States expanded around the Covid-19 pandemic, and will likely remain an integral part of medical care as providers, payers, and government agencies commit to accessible and cost-effective care options. The Consolidated Appropriations Act of 2023 (CAA) extended many telehealth flexibilities through the end of 2024, meaning medicare patients can continue to receive telehealth services no matter where they live in the United States. Many highly utilized telehealth services such as virtual check-ins and telehealth consultations have CPT codes, The Current Procedural Terminology for coding medical services and procedures, which allow them to be billed by insurance.
However, the AMA has not approved CPT codes to authorize the billable use of expanded at-home diagnostics beyond PCR testing, such as for STI screening, which limits the future of remote care beyond the pandemic. Labs can bill for the results of the test itself, but not the whole at-home diagnostic care flow. CPT codes need to take into account the full at-home diagnostic testing experience, such as the physical kit, shipping, or necessary tech. Throughout the diagnostic lifecycle, a patient may incorrectly submit a self-collection sample and require a replacement kit, or a public health department may need access to engineers and client success specialists. As the billing process stands, the patient would be responsible for covering the cost of these services, which become exponentially more crucial when at-home testing operates at scale.
In 2022, California became the first state to require insurance plans to cover at-home tests for STIs, but even then the lack of CPT codes caused problems. Medi-Cal, the California Medicaid program, did not have the billing codes ready to start paying for tests by the required state date, and the stakes are high. Among other sky-high STI rates, female early syphilis cases increased in California over 1,181% between 2011 and 2020.
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There are incomplete solutions to finance at-home diagnostics for businesses and organizations beyond CPT codes. Businesses can partner with payers directly to bill around at-home diagnostic testing for specific verticals or in some cases, such as with HIV/STI screening as part of PrEP medication maintenance, use 340b funding. Traditional medical institutions can enact temporary HIV/STI screening programs with funding from Ryan White. However, the simplest and most cost-effective solution for public health entities, medical institutions, and digital health is for the AMA to approve a remote STI screening CPT code that bills for all aspects of at-home diagnostics.
Photo: d3sign, Getty Images
David Stein is the CEO of Ash Wellness, a B2B at-home diagnostic company launching remote care services for healthcare organizations and D2C businesses. Ash Wellness offers white-lable operations management, testing via a CLIA/CAP certified lab network, kitting and fulfillment, and modern technology infrastructure. In his role, David is responsible for mission vision, strategy oversight, fundraising, and corporate development. He is a graduate of the Cornell Tech MBA program.
