# 87428



## mgortega23 (Nov 17, 2020)

Anyone billing the new COMBO( Flu and COVID) lab 87428?


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## magosto (Nov 18, 2020)

Not yet but we plan to. Waiting for guidance from CMS.


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## ljhaley@gmail.com (Jan 13, 2021)

We'd like to, but not because none of our commercial carriers have added it to their systems, nor set any reimbursement rates. 
However they HAVE done so for 87426 if that helps at all.  I am NY based. Good luck!


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## kristiblevins1 (Jan 27, 2021)

We billed claims for the 87428 with QW modifier and denied stating incomplete invalid procedure modifier.  I called First Coast Medicare and spoke with a rep that stated the QW is not associated with procedure 87428.  Anyone else having this issue? Everything I read on this subject states it is a clia waived test.  Our CLIA certificate is up to date.


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## jennifer.r.wake (Feb 3, 2021)

kristiblevins1 said:


> We billed claims for the 87428 with QW modifier and denied stating incomplete invalid procedure modifier.  I called First Coast Medicare and spoke with a rep that stated the QW is not associated with procedure 87428.  Anyone else having this issue? Everything I read on this subject states it is a clia waived test.  Our CLIA certificate is up to date.


We are having the same problem with our MAC (WPS GHA). I am also seeing everywhere that it is a CLIA waived test that should be billed with modifier QW as of 11/10/2020 but we are still getting denials from Medicare.


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## kristiblevins1 (Feb 9, 2021)

jennifer.r.wake said:


> We are having the same problem with our MAC (WPS GHA). I am also seeing everywhere that it is a CLIA waived test that should be billed with modifier QW as of 11/10/2020 but we are still getting denials from Medicare


Thank you for responding.  Any updated info on this?


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## jennifer.r.wake (Feb 11, 2021)

kristiblevins1 said:


> Thank you for responding.  Any updated info on this?


I just received a call from our MAC (WPS GHA) after sending an inquiry to them about it. They pointed out that the MLN/CR 12093 that talks about the addition of modifier QW  to 87428 was effective 10/06/2020, but the "implementation date" is not until 04/05/2021 - which I was told means their systems will not recognize it until then. So, I've been told that any claims received before 04/05/2021 will likely continue to be rejected and that we will need to contact them to reprocess all of them. In our case, we can do that on their website instead of calling in on every single one - I hope that's the case for you, too!

Update - They called me back and said we won't be able to ask for them to be reprocessed until after the implementation date of 04/05/2021, either. But that since ours are rejecting as unprocessable, we should be able to just resubmit, instead of having to ask for them to be reprocessed.


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## lemorris (Feb 19, 2021)

I was wondering if 87428 was billed once for each test. The code is for Flu A+B and Covid but I found an article that stated "When separate results are reported for different species or strain of organisms, each result should be coded separately. Use modifier 59 when separate results are reported for different species or strains that are described by the same code."
Are any of you billing this like 87428-QW + 87428-QW,59 + 87428-QW,59 when doing all 3 tests?


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## rigdon72 (Oct 14, 2021)

lemorris said:


> I was wondering if 87428 was billed once for each test. The code is for Flu A+B and Covid but I found an article that stated "When separate results are reported for different species or strain of organisms, each result should be coded separately. Use modifier 59 when separate results are reported for different species or strains that are described by the same code."
> Are any of you billing this like 87428-QW + 87428-QW,59 + 87428-QW,59 when doing all 3 tests?


lemorris, did you get any response to this?? We have a clinic using a machine that tests all 3 with one sample.  I am hesitant to bill 3 units, because the description states "AND" not "OR" like 87400 does.


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