New COVID-19 Test Codes Effective Immediately

New COVID-19 Test Codes Effective Immediately

Just when you thought you had all the COVID-19 coding for laboratory testing figured out — hold the phone — there are three new CPT® codes.

These newest codes are effective June 25, 2020.

CPT® CodeLong Descriptor
0223UInfectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected

(For additional PLA code with identical clinical descriptor, see 0202U. See Appendix O or the most current listing on the AMA CPT website to determine appropriate code assignment)
0224UAntibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed (Do not report 0224U in conjunction with 86769)
87426Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

CPT® code 87426 reports infectious agent antigen detection by immunoassay technique of SARS-CoV and SARS-CoV-2, and it will be a child code under parent code 87301. The two new proprietary laboratory analyses (PLA) codes (0223U and 0224U) are for detection of SARS-CoV-2.

“The new CPT code for antigen testing to detect the coronavirus is the latest in a series of CPT codes developed in rapid response to the pandemic,” said AMA President Susan R. Bailey, MD.

Health and Human Services Secretary Alex Azar declared a public health emergency in the entire United States on Jan. 31, 2020. President Trump declared a national emergency on March 13, 2020.

See “COVID-19 Specimen Collection and Testing” for a list of all the new testing codes, with effective dates and Medicare payment rates.

The Food and Drug Administration says in a May 9 statement that antigen tests are less costly to produce than polymerase chain reaction (PCR) tests and “are highly accurate.” There is a higher chance of false negatives, however, so negative results from an antigen test may need to be confirmed with a polymerase chain reaction (PCR) test.

CPT® Assistant has issued a special edition with advice on SARS-CoV-2 laboratory testing, including antigen testing.

UPDATE: See MLN Matters article MM11815 Revised, released July 8, 2020, for Medicare guidance on use of these new codes.

UPDATE: MLN Matters article 11927, released July 24, notifies us about the addition of the QW modifier to 87426.


Source:
O’Reilly, Kevin, “CPT code approved for SARS-CoV-2 antigen testing,” AMA, June 26, 2020.

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Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

13 Responses to “New COVID-19 Test Codes Effective Immediately”

  1. Ameena tk says:

    Doesn’t corona virus have icd codes ?

  2. Renee Dustman says:

    Yes, effective April 1, 2020, report confirmed cases with U07.1 COVID-19

  3. Julie Fuller says:

    So for CPT 87426 do I also need to report 87301

  4. Barbara Thom says:

    What does it mean that 87426 will be a child code under parent code 87301?

  5. Renee Dustman says:

    no

  6. Renee Dustman says:

    The parent code describes the main service and the child codes describe variations. 87301 describes infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [EKISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step meh=thod; adenovirus enteric types 40/41
    87426 describes everything in 87301 up to the semicolon and severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

  7. Kristi Andrew CPC, says:

    has CMS announced the allowable amount for new cpt code 87426…thank you!

  8. Renee Dustman says:

    No, CMS has not added a value to 87426 in the physician fee schedule.

  9. Karen Kundinger says:

    Do you need a QW code with 87426 in a CLIA Waived lab? I can’t find anything definite out there, but we are hitting edits in our system for Medicare.

  10. Sikha Purohit says:

    Hi Ms. Renee,
    Our lab recently started antigen testing for COVID-19 patients. With no assigned value by CMS for 87426, how should I use 87426 if I submit claim? Should I use the modifier “CS”? Any suggestion would be greatly appreciated.

  11. Renee Dustman says:

    Please see this updated guidance from CMS https://www.cms.gov/files/document/MM11815.pdf

  12. Renee Dustman says:

    Please see this updated guidance from CMS https://www.cms.gov/files/document/MM11815.pdf

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