New codes for COVID-19 antibody tests

Editor's note: on June 24, the CPT Editorial Panel approved the addition of a new code for reporting antigen testing, which is designed to be a quicker way to identify patients infected by the novel coronavirus. The new code and long descripter is "87426: Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19])."   

Antibody tests to determine who has developed an immune response to COVID-19 are not widely available yet. But they could play a role in determining the true prevalence of the illness in a given area and determining who can safely return to normal activities.

The American Medical Association (AMA) recently released expedited CPT updates that include two new codes, effective April 10, for COVID-19 antibody tests:

86328 — Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).

86769 — Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).

Code 86328 should be used for antibody tests with a single-step method immunoassay — typically a strip with all the necessary components for the assay, appropriate for a point-of-care testing platform. Report 86328 once per reagent strip. If more than one reagent strip is used, modifier 59 (distinct procedural service) should be appended to the code for the second reagent strip assay to identify two distinct analyses were performed.

Code 86769 should be used for antibody tests with multi-step methods. When two distinct analyses are performed (e.g, IgG and IgM), 86769 is reported on two claim lines with modifier 59 (distinct procedural service) appended to 86769 on the second claim line.

Blood sample collections are reported with CPT code 36415 (Collection of venous blood by venipuncture) or 36416 (Collection of capillary blood specimen, e.g., finger, heel, ear stick).

Though there may be many tests being marketed right now, as of April 18 the Food and Drug Administration (FDA) had approved only four for detecting COVID-19 antibodies. All four were approved under the FDA’s emergency authorization program.

The antibody test codes come on the heels of a new CPT code for COVID-19 diagnostic testing instituted last month:

87635 — Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.

The AMA has more information about the new codes here.

Additionally, the AMA’s CPT Assistant is providing two fact sheets for coding guidance for the SARS-CoV-2 (COVID-19) test in relation to the use of the new CPT codes. You can find both the March 13 fact sheet and April 10 fact sheet on the AMA website.

Lastly, the Centers for Medicare & Medicaid Services first issued new HCPCS codes for COVID-19 testing last month, and has since added more codes released last week.

— Kent Moore, Senior Strategist for Physician Payment