COVID-19 Testing?

[vnorman]

It is my understanding that code 86328 has been introduced for COVID-19 testing. Does anyone have any information as to what POS needs to be used for this? Also is this a CLIA waived test? Does this test have to be billed from a lab or can it be billed from a providers office? My office has taken the JUMP and decided we are going to do these and I am now trying to obtain all the correct billing information.

 

[SWsibemom]

This CPT Assistant states POS is not specifically addressed, but this may answer some of your questions.

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

 

[karamac]

The CPT code does not delineate whether a test is CLIA waived or not, the test/kit/device is what determines the level of CLIA that is needed. (Example, there are multiple codes in the chemistry section of CPT where the code is used for both waived and non-waived laboratory methods) What you have bought should be labeled as CLIA waived, if it isn't-- buyer beware.

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

The above is the link to the FDA website, it will list the CLIA waived devices that are available, if your kit/test is not listed, that does not mean that it isn't, it just may be in the 15 day window between authorization and application. With that being said, I would not recommend the use of any kit that is not listed on the FDA site. There are too many bad actors in the space currently and many of the test kits (POCT) are offerring less than 60% specificity to the Co-VID 19 antibody. This means that the kit you are using is validated only to the ENTIRE coronavirus family-- including the common cold. Buyer beware on these kits, Quest and Labcorp both have either direct to consumer or in home testing kits, and most hospitals and regional labs can provide serology testing at collection sites that is then run on lab instrumentation in the lab. The results may take a little longer, but they are at least reliable.

 

[brepola]

Has anyone billed the 86769 w/ Z01.84 and obtained reimbursement or notification of pending reimbursement? what was the fee schedule? No one knows

 

[karamac]

86789 is for the multi-step method for antibody testing that is performed on an ELISA instrument in the laboratory. CP As of this morning, the CLFS had not been updated with pricing. Per CPT Assistant...

"The new codes will allow accurate reporting and tracking of tests performed specifically for COVID-19 caused by SARS-CoV-2. Code 86328 was established as a child code to 86318 to report a qualitative or semiquantitative single-step method immunoassay for SARS-CoV-2 (COVID-19) antibody(ies). Code 86769 was established to report an antibody test for SARS-CoV-2 (Coronavirus disease [COVID-19]) using a multiple-step method. Note that code 86769 will be a child code under parent code 86710. It is represented here in its entirety, ie, complete long descriptor, including the language from parent code 86710."

I counsel my laboratories to look at the reimbursement aligned with the parent code, which in this situation is 86710. The reimbursement for 86710 is $13.55. I know that it may be confusing as to why AMA would put a Coronavirus antibody test as a child code to an influenza parent code, this is probably due to the code being based on the method of testing rather than the pathogen. CMS has increased the reimbursement for the diagnostic (molecular PCR) to $100, so I would assume that for a short time due to the pandemic that the CLFS rate for 86789 will be a little higher than the parent code reimbursement. But as you said, right now it is anyones best guess.

 

[runninghonu@yahoo.com]

It is my understanding that code 86328 has been introduced for COVID-19 testing. Does anyone have any information as to what POS needs to be used for this? Also is this a CLIA waived test? Does this test have to be billed from a lab or can it be billed from a providers office? My office has taken the JUMP and decided we are going to do these and I am now trying to obtain all the correct billing information.

86328 is a finger prick test - I talked to the manufacturer and found that it is not clia waived https://aytubio.com/covid-19/ ... there might be others out there, by now. There is not a code for the nasal swab test offered by QUIDEL - this is an Antigen test as opposed to Antibody and reported as performed via Nucleic Protein as opposed to Nucleic Acid.

 

[karamac]

86328 is a finger prick test - I talked to the manufacturer and found that it is not clia waived https://aytubio.com/covid-19/ ... there might be others out there, by now. There is not a code for the nasal swab test offered by QUIDEL - this is an Antigen test as opposed to Antibody and reported as performed via Nucleic Protein as opposed to Nucleic Acid.

Serology testing (86328) can be performed by multiple types of collection on blood, serum, plasma etc. using finger prick, dried blood spot, veinpuncture. The antigen test, as of now can be billed using U0002 per CMS guidance. The Quidel testing platform tests multiple other pathogens and viruses, so we should expect to see a code soon. Serology testing, for now is losing steam as it is not being used by most states as a return to work test and the reliability of the testing is very questionable, specifically positivity rates.

 

[skrol210]

our office is looking into providing the rapid covid tests cpt code 87426. has anyone been doing this already in their office? is this test clia waived? also are insurance companies reimbursing for this

 

[karen.landry2010@gmail.com]

I'm curious if anyone knows what frequency the COVID-19 tests can be billed? I.e., will Medicare pay one per month? One per week? I am finding general references that this may depend on the location of the patient - inpatient, SNF, homebound/HHA, but I'm finding nothing definitive. If anyone's got any leads or info I'd be much obliged!