New and revised codes for COVID-19 testing

The American Medical Association (AMA) CPT Editorial Panel approved new and revised codes for COVID-19 testing this week. The updates to the CPT code set take effect immediately.

The new codes are:

87636 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique.

87637 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique.

The panel also revised CPT codes ranging from 87301 to 87430 by removing the undefined term “multi step method” from the code descriptors. This revision clarifies how to properly report antigen tests that are read by a machine, as compared to those which can be visually interpreted without a machine. The change affects the newly developed descriptor for COVID-19 antigen tests described in CPT code 87426:

87426 - Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).

In conjunction with that revision, the panel approved a new category I code, 87811, to report infectious agent antigen detection by immunoassay with direct visual observation:

87811 - Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).

Descriptors for these codes and others can be accessed on the AMA website, along with several other recent modifications to the CPT code set that have helped streamline the public health response to the SARS-CoV-2 virus and COVID-19 disease. There is no word yet on whether Medicare or commercial insurers will cover and pay for the new codes.

For more on COVID-19 testing, see this American Academy of Family Physicians (AAFP) webpage.

— Kent Moore, Senior Strategist for Physician Payment, AAFP