Wiki Different cpt codes for covid PCR vs Rapid

[mgarcia400]

I work for a Family practice and we currently do PCR COVID swabs that are sent out to a lab. We use cpt 87635 for billing. We are currently trying to obtain the covid rapid tests, I'm having trouble identifying if there would be a different cpt code used for a rapid vs a pcr. Can anyone advise me if there is a different code used for rapid test?

Thanks

 

[sls314]

The AMA website has page for COVID-19 CPT coding and guidance. That's probably the most accurate resource to find any COVID-19 related CPT code.

https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance

It looks like CPT 87426 (infectious agent antigen detection by immunoassay technique of SARS-CoV and SARS-CoV-2) is probably the one you're looking for, but you can check the fact sheets on the AMA link above to be certain.

 

[csperoni]

I work for a Family practice and we currently do PCR COVID swabs that are sent out to a lab. We use cpt 87635 for billing. We are currently trying to obtain the covid rapid tests, I'm having trouble identifying if there would be a different cpt code used for a rapid vs a pcr. Can anyone advise me if there is a different code used for rapid test?

Thanks

If you are sending the tests to be done in an outside lab, shouldn't the lab be billing 87635? If you are doing the testing in house, then you would bill the 8xxxx lab code.
And definitely the link provided above by @sls314 is a great resource!!

 

[susan.ellis]

I work for a Family practice and we currently do PCR COVID swabs that are sent out to a lab. We use cpt 87635 for billing. We are currently trying to obtain the covid rapid tests, I'm having trouble identifying if there would be a different cpt code used for a rapid vs a pcr. Can anyone advise me if there is a different code used for rapid test?

Thanks

If the Pt presents for a PCR test and you are ONLY performing the swab in the office/UC/ER but sending the swab to a lab you would code a level 1 or 2 EM and append -CS mod. That is only if the Physician performs the key components of an EM. If only the swab was performed by an NPP then you can't bill for the EM at all.

The only instance CPT 87635 can be billed outside of a clinical lab is if the PCR swab is performed and results processed in office via the ID NOW Molecular SARS Cov2 RNA device owned by your office, in a non-clinical lab POS. This is because the code descriptor for 87635 specifically states, "amplified probe technique" which can only be performed by a clinical lab or the ID NOW device. Your practice's CLIA certification would need to be updated to authorize billing 87635 due to owning an ID NOW device. If your CLIA certification is not updated then it will deny.

CPT 87426 is the correct code for a POCT Rapid SARS-CoV-2 swab collected and performed on site/in office.
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

CPT 87428 is the correct code for when POCT Rapid SARS-CoV-2 AND POCT Rapid Influenza A/B are BOTH performed
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

Hope this helps clarify!

 

[mgarcia400]

If the Pt presents for a PCR test and you are ONLY performing the swab in the office/UC/ER but sending the swab to a lab you would code a level 1 or 2 EM and append -CS mod. That is only if the Physician performs the key components of an EM. If only the swab was performed by an NPP then you can't bill for the EM at all.

The only instance CPT 87635 can be billed outside of a clinical lab is if the PCR swab is performed and results processed in office via the ID NOW Molecular SARS Cov2 RNA device owned by your office, in a non-clinical lab POS. This is because the code descriptor for 87635 specifically states, "amplified probe technique" which can only be performed by a clinical lab or the ID NOW device. Your practice's CLIA certification would need to be updated to authorize billing 87635 due to owning an ID NOW device. If your CLIA certification is not updated then it will deny.

CPT 87426 is the correct code for a POCT Rapid SARS-CoV-2 swab collected and performed on site/in office.
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

CPT 87428 is the correct code for when POCT Rapid SARS-CoV-2 AND POCT Rapid Influenza A/B are BOTH performed
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

Hope this helps clarify!

Thank you for the clarification!