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COVID-19 antibody tests

B

brepola

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8
Location
Scottsdale, AZ
I have been looking for days for a fee schedule for the new antibody testing codes: 86328 and 86769. What are your offices charging for these?? Also how are you handing out of network plans, paying at TOS? Self pay patients?

 
I have been checking daily for insurance allowables for the Antibody testing. My Clients are thinking of charging $ 25.00-$ 30.00 as cash for now since Carriers don't have these codes on their fee schedules yet. fingers crossed it will be soon --test kits are arriving soon
 
As of last night the CLFS has not been updated with pricing specific to the new serology testing codes that have been released by the AMA. The newly created CPT code 86328 is what is being termed a "sister code" to CPT code 86318 that prices at $18.03 per the fee schedule from my memory. A safe bet that the pricing would be crosswalked from 86318 to 86328. Codes should be loaded at payers.

Remember that the test kits (the quick POCT serology kits) are not going thru the FDA's EUA process. What that means to your practice and to your patients is that while you can use them, the validity and specificity have not been independently evaluated by the FDA. Of the kits that I have reviewed for clients, all have fallen under CPT code 86328, even when both IgG and IgM are part of the lateral flow assay. I have also attached a link to a website that is tracking these tests as they come onto the market.

https://www.360dx.com/coronavirus-test-tracker-launched-covid-19-tests

This is the FDA EUA site and also has links to FAQ's..

https://www.fda.gov/medical-devices...-medical-devices/emergency-use-authorizations

From a diagnosis code standpoint, there is not specific guidance from CPT yet, but the AHA published guidance yesterday that another forum member was kind enough to post, see FAQ #20. Important to remember that there are not diagnostic edits in place specific to this testing.
 

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This is all great information!

I have been searching high and low, as well, for a fee schedule for CPT 86769 and cannot find one anywhere still. Has anyone had success with this yet?

Thank you for all of your help!
 
I finally rec a response from my BCBS provider rep who states that BCBS of AZ is set to pay $15.63 for 86769, however I haven't rec any back yet. Has anyone else? Also there's some discussion about what DX we are using. I mentioned that the recommendation for a patient who doesn't know if they have had exposure or not - having no clue one way or another, to use: Z01.84 but the logic at our office is that if you don't know but you "suspect" you were exposed so it would be ok to use the exposure/suspected exposure code. Thoughts?
 
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