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 managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

19 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

  13. michelle says:

    In response to the Parent code 87301 and child code 87426. Is there any reason that the child code 87426 could not be sent by itself or would the Parent code 87301 need to be as well?

  14. Renee Dustman says:

    No, use whichever code describes the procedure most accurately.

  15. Alyssa says:

    I am still trying to determine a fee for 87426. How is everyone establishing one?

  16. ANISH says:

    Any update about Medicare reimbursement for 87426?

  17. Shirley Cox says:

    Does code 87426 need QW modifier for commercial insurance companies?

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