New COVID-19 Testing Codes

New COVID-19 Testing Codes

During an emergency meeting in response to the COVID-19 crisis, the American Medical Association (AMA) convened the CPT® Editorial Panel to approve a new pair of Category 1 CPT® codes. These two new codes are effective immediately, according to the AMA.
“The new codes are intended for use as the industry standard for accurate reporting and tracking of blood tests performed to specifically detect antibodies associated with the SARS-CoV-2 virus,” according to the AMA release.

New Codes for Antibody Testing

The new codes are:

  • 86328 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
  • 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

CPT® 86328 is for antibody tests using a single-step method immunoassay. This often includes a strip with all of the critical components for the assay, and is appropriate for a point of care platform, according to an AMA press release. CPT® 86769 is for antibody tests employing a multiple-step method.

For more up-to-date information on testing codes, click here.

Antibodies Show Promise

“Antibody testing that identifies patients that have been exposed to the novel coronavirus (SARS-CoV-2) and developed an immune response is likely to have important public health implications by providing a clearer picture of the prevalence of the disease in the U.S.,” said AMA President Patrice A. Harris, MD, MA, in the press release. “The expedited approval of new CPT® codes for COVID-19 antibody tests is an important step that enhances the reporting of innovative tools now available to advance medicine’s overarching goals of reducing the COVID-19 disease burden, improving health outcomes and reducing long-term care costs.”
The AMA has released a free CPT® Assistant Special Edition: April Update to guide the healthcare industry on using these new codes.

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Chris Boucher, CPC
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Chris Boucher, CPC, has 10 years of experience writing various newsletters and other products for The Coding Institute. His blog covers several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance, and ICD-10 coding.

14 Responses to “New COVID-19 Testing Codes”

  1. Cindy says:

    Thanks for the article. This is good news. Has there been any reimbursement information on these two codes? Thanks again for the information

  2. Marlene Shorey says:

    Question – The 2 new CPT codes, do you know when to expect them on the Medicare Fee schedule? I am looking speciftfor CPT 86328v I keep checking each day. I am trying to get code loaded o to my EhR and priced, and o l ow our team used fees from Medicare fee schedule as a guide. Do you lknow when we can expect to see the code on any geek schedule?

  3. Renee Dustman says:

    Codes 86328 and 86979 are available for reporting beginning April 10, 2020. Contact your third party payer to determine their guidelines regarding reimbursement

    https://www.ama-assn.org/system/files/2020-04/cpt-assistant-guide-coronavirus-april-2020.pdf

  4. Susan Heiss says:

    The CPT codes 86769 and 86328, do you know when Medicare will report the reimbursement?

  5. Renee Dustman says:

    I believe the April 2020 MPFSDB has been updated.

  6. MaryNell Goolsby says:

    Do you have recommended ICD-10 codes for coverage? Z03.818? Z20.828? Will Z11.59 be covered for antibody testing?

  7. Renee Dustman says:

    MaryNell: Z03.818 is used for an asymptomatic patient with possible exposure to COVID-19 and the patient tests negative. Z20.828 is used for a patient known or suspected to be exposed to COVID-19, who is exhibiting symptoms, but test results are negative, inconclusive or unknown.

    Report U07.1 if test results are positive.

  8. Tiffany says:

    What is the appropriate COVID 19 testing code for specimen/swab collection in a doc office? I read that Medicare is allowing 99211 for this test via doc office. Is that accurate?

  9. Renee Dustman says:

    Tiffany: Yes, per a CMS Fact Sheet, dated 4.29.2020, “Practitioners can be paid for assessment and specimen collection for COVID-19 testing using the level 1 evaluation and management code CPT code 99211. In light of the public health emergency, Medicare will recognize this code to be billed for all patients, not just established patients.”

  10. Linda says:

    Question–If a nursing facility bought a COVID-19 testing kit for their residents, what HCPCS or CPT code is applicable to use by a nursing facility to be able to bill Medicare B or Commercial Insurance and get reimbursed? I am looking at G2024 which is the specimen collection. Is there any other code we could use to bill? What Revenue code is appropriate to use for specimen collection?

  11. Renee Dustman says:

    G2024 is applicable to patients in a non-covered stay in a SNF and not to
    those residents in Medicare-covered stays (whose bundled lab tests would be covered
    instead under Part A’s SNF benefit at §1861(h) of the Act).

  12. Kasi Martinez says:

    What code would i use if a strip is used with multiple-step before procedure is done for endoscopy? I was looking at 86768. What dx code can be used?

  13. Renee Dustman says:

    Kasi, I recommend that you post this question in our coding/billing forums!

  14. Renee Dustman says:

    Per the Coding Clinic Advisor guidance, coding professionals should use the following ICD-10-CM codes to report an encounter for antibody testing performed on a patient with resolved (a history of) COVID-19:

    Z09, encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
    Z86.19, personal history of other infectious and parasitic diseases
    If the encounter for antibody testing is performed on a patient with unresolved COVID-19, the coder would instead report U07.1 (2019-nCoV acute respiratory disease).

    If the encounter for antibody testing is not performed to confirm a current COVID-19 infection, nor is performed as a follow-up test after resolution of COVID-19, coders should assign ICD-10-CM code Z01.84 (encounter for antibody response examination). (from https://acdis.org/articles/tip-covid-19-antibody-testing-and-cdicoding-professionals)

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