Considerations for physicians ordering SARS-CoV-2 PCR diagnostic testing

Updated Aug. 20, 2020

This is the first article of a two-part series on considerations for SARS-CoV-2 PCR diagnostic testing. Read the previous articles from the series Considerations for SARS-CoV-2 PCR diagnostic testing.

Polymerase chain reaction (PCR) diagnostic testing for SARS-CoV-2, the virus that causes COVID-19, has been fraught with challenges since the current pandemic reached the United States. Learn more about the considerations for physicians ordering PCR diagnostic testing for SARS-CoV-2.

1. Considerations for Physicians Ordering SARS-CoV-2 PCR Diagnostic Testing (PDF)

   1. Download the complete overview of the considerations for physicians ordering PCR diagnostic testing for SARS-CoV-2.

As demand for PCR diagnostic testing services continues to outpace capacity, the AMA recommends ordering physicians carefully consider when to recommend PCR diagnostic testing for SARS-CoV-2. At this time, the AMA recommends that physicians consider prioritizing testing services for those individuals with a medically indicated need for diagnostic testing. These individuals include those exhibiting COVID-19 symptoms, those with a known exposure to SARS-CoV-2, those requiring a negative SARS-CoV-2 test to pursue medical treatment or procedures, and health care workers¹.

For other individuals not at an immediate-risk of illness or other medically indicated need for testing, at-home quarantine would likely serve the purpose of limiting risk of transmission to others while easing demand on the testing capacity. Individuals not at immediate-risk of illness or other medically indicated need may include those wishing to engage in social gatherings, those who have previously participated in social gatherings but do not have a known exposure, those wishing to engage in non-essential travel and those returning to work or school. Where there is no medically indicated need for testing, we encourage physicians to consider recommending at-home quarantine in lieu of testing. As the demand for testing services is dynamic, these recommended considerations may change should demand for testing ease, availability of testing supplies improve, or if new tests with acceptable performance become widely available.

We further encourage physicians to provide certain counseling to patients seeking testing for SARS-SoV-2. If a patient presents with symptoms of COVID-19 or a known exposure to COVID-19, it is critical that providers counsel patients on the importance of at-home quarantine until test results are received. Potentially infected patients choosing not to quarantine during this time risk transmission to others and clear counseling to this effect is critical to help limit spread of this disease. The Centers for Medicare and Medicaid Services and the Centers for Disease Control have announced their intent to reimburse physicians for these counseling services².

Physicians should further counsel their patients about what a negative SARS-CoV-2 test result means. It should be made clear to patients that a negative test result means only that patients were SARS-CoV-2 negative at the moment in time when the sample was collected and that they will not necessarily continue to be negative in to the future. It is possible that patients could be infected in the hours or days after receiving the test result or were tested too early during the course of illness. Those with negative test results must continue to follow all public health protocols, including physical distancing, employing good hand hygiene practice and wearing face masks in public and/or where physical distancing is not possible. The AMA recognizes that there is likely need for testing of asymptomatic individuals as part of public health surveillance efforts. The AMA continues to advocate for the development of a well-defined surveillance strategy for COVID-19 infections. Patients participating in such efforts should be included as those with a prioritized need for testing services.

• Considerations for the general public seeking SARS-CoV-2 PCR diagnostic testing
• Considerations for SARS-CoV-2 PCR diagnostic testing overview

¹This list is not exhaustive and other individuals may have legitimate medically indicated needs for testing services. These requests should be considered on a case-by-case basis.

² CMS and CDC announce provider reimbursement available for counseling patients to self-isolate at time of COVID-19 testing