AMA Advocacy Insights webinar series examines key advocacy issues from the federal and state levels impacting patients and physicians. answers regarding the SARS-CoV-2 (COVID-19) test in relation to the use of the new CPT code 87635. The ICD-10 codes submitted are consistent with the reason why the patient visited the physician and the diagnosis but also includes whether or not the patient had previous confirmed exposure to coronavirus, or only suspected exposure to someone with coronavirus. We have come up with 87635,QW. (CMS-2020-01-R). % Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. iPhone or If its the former, bill with ICD-10 code Z20.828. Use the following codes for antibody detection for COVID-19 for dates of service on or after April 10, 2020: To help you understand how UnitedHealthcare will reimburse services during the national public health emergency period, we created a COVID-19 testing and testing-relates services billing guide. The HOD speakers welcome comments for reports under development for the upcoming Interim and Annual Meetings. If it's only suspected exposure to coronavirus, bill ICD-10 code Z03.818. We had an opportunity to confer with the American Medical Association, their CPT experts, and the Federation of Medicine a short while ago. We want to thank everyone for their continued patience around coding protocols as they continue to evolve for the coronavirus and coronavirus testing. 3 MIN READ AMA announces CPT update for third dose of Pfizer's pediatric COVID-19 vaccine Review the agenda for the 2023 Medical Student Advocacy Conference (MAC) taking place in Washington, D.C., March 2-3, 2023. Collaborating and networking to advocate for patients and the medical profession. Access a file with the new CPT codes for testing and vaccine products and vaccine administrations. The code joins other COVID-19 testing codes already approved by the CPT Editorial Panel, an independent body convened by the AMA that has the sole authority to expedite the review of proposed changes and additions to the CPT code set. In this case, for billing of a coronavirus test from a laboratory. Download the Nov. 10, 2020 CPT Assistant guide (PDF, includes information on code 87428 ) This is applicable only for UnitedHealthcare Individual and Group Market health plans, and only to urgent care facilities on an all-inclusive Per Case, Per Diem, Per Visit, Per Unit, etc. vY5 r,"bA*TXVs H2JyE*$X%[0;L:i Rz@L*`$x2@ H& COVID-19 CPT vaccine and immunization codes page. Explore reports on this topic from the Council on Medical Education presented during the AMA Interim and Annual Meetings. Drive in style with preferred savings when you buy, lease or rent a car. The benefits and processes described on this website apply pursuant tofederal requirements and UnitedHealthcare national policy during the national emergency. The CPT Editorial Panel has developed several CPT codes for COVID-19 infectious agent detection, antibody, and antigen testing. Fingers crossed we are on the right track. Review the agenda for the 2023 Medical Student Advocacy Conference (MAC) taking place in Washington, D.C., March 2-3, 2023. To request permission to reproduce AHA content, please click here. contract rate. I verify that Im in the U.S. and agree to receive communication from the AMA or third parties on behalf of AMA. endstream endobj 324 0 obj <. UnitedHealthcare will follow CDC guidelines and state requirements regarding testing limits. Special editions of CPT Assistant also provide coding . This applies to all, Laboratory receives physician order and patient specimen for testing, Laboratory performs testing and reports test results. With this in mind, negative results from an antigen test may need to be confirmed with a PCR test prior to making treatment decisions or to prevent the possible spread of the virus due to a false negative.. Expert Answers: Diagnosis Coding. 246 0 obj <>/Filter/FlateDecode/ID[<34C0CA4F4C553C408B502AF7B985F95C>]/Index[221 54]/Info 220 0 R/Length 123/Prev 333067/Root 222 0 R/Size 275/Type/XRef/W[1 3 1]>>stream The AMA is closely monitoring COVID-19 (2019 novel coronavirus) developments. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> For a better experience, please enable JavaScript in your browser before proceeding. CPT 87426 is the correct code for a POCT Rapid SARS-CoV-2 swab collected and performed on site/in office. Individual and Group Market health plans and Individual and Family Plans* Use CPT codes 99000 and/or 99001 *Individual and Family Plans were previously referred to as Individual Exchange. endstream endobj 222 0 obj <>/Metadata 17 0 R/Pages 219 0 R/StructTreeRoot 36 0 R/Type/Catalog/ViewerPreferences<>>> endobj 223 0 obj <. CPT Copyright 2020 American Medical Association. endobj And that will be consistent with whether or not the patient had previous confirmed exposure to someone with coronavirus or only suspected exposure to someone with coronavirus. Effective April 1, 2020, a new ICD-10-CM diagnosis code chapter, Chapter 22 Codes for Special Purposes (U00-U85) and new code U07.1 COVID-19 was made available for reporting the coronavirus diagnosis. This code should be used when billing for add-on payment to laboratories for a COVID-19 diagnostic test run on high throughput technology if the laboratory a) completes the test in 2 calendar days or less, and b) completes the majority of their COVID-19 diagnostic tests that use high throughput technology in 2 calendar days or less for all of their patients (not just their Medicare patients) in the previous month. 490 0 obj <>stream The HOD speakers welcome comments for reports under development for the upcoming Interim and Annual Meetings. Medicare will pay for COVID-19 tests performed by pharmacists as part of a Medicare- . We have sought guidance and input from AMA CPT committee in the development of all billing scenarios. Why its important: Antigen testing is designed to be quicker and simpler than other tests for the coronavirus and could be conducted at the point of care. AMA and CPT are registered trademarks of the American Medical Association. hbbd```b``@$uf"/$3d U)"mA$&,k "EL)`DZdI)z]&rb`&g _ Lab coding is a foreign language for me! 443 0 obj <>/Filter/FlateDecode/ID[<088476E6C9A8994AB01CD6250A50F599>]/Index[405 86]/Info 404 0 R/Length 162/Prev 260640/Root 406 0 R/Size 491/Type/XRef/W[1 3 1]>>stream You are using an out of date browser. contract rate: Use CPT code 87635 for lab testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2). For quick reference, the new Category I CPT codes and long descriptors are: 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]). The codes are for multi-virus tests that can detect both COVID-19 and other viruses, like the flu. This code should be used for clinical diagnostic laboratory tests that use high-throughput amplified probe technologies to detect and diagnose COVID-19. Use CPT code 99001 or 99211, where appropriate. The new code is intended for use as the industry standard for accurate reporting and tracking of antigen tests using immunofluorescent or immunochromatographic technique for the detection of biomolecules produced by the SAR-CoV-2 virus. Learn more with the AMA's COVID-19 resource center. Visit the COVID-19 CPT vaccine and immunization codes page, Coronavirus (SARS-CoV-2): Long descriptors, Coronavirus (SARS-CoV-2): Medium descriptors, Coronavirus (SARS-CoV-2): Short descriptors, Download the Nov. 10, 2020 CPT Assistant guide, Download the Oct. 6, 2020 CPT Assistant guide, Download the Sept. 8, 2020 CPT Assistant guide, Download the Aug. 10, 2020 CPT Assistant guide, Download the June 25, 2020 CPT Assistant guide, Download the May 20, 2020 CPT Assistant guide, Download the April 10, 2020 CPT Assistant guide, Download the March 13, 2020 CPT Assistant guide, Quick reference flow chart for CPT reporting for COVID-19 testing, Coding scenarios and how to apply best coding practices, COVID-19 CPT vaccine and immunization codes, Connecting Promise and Practice: The Trajectory of Digitally Enabled Care, How the CPT code set can be used to help advance health equity, New study tallies excess physician deaths during early pandemic, What doctors wish patients knew about heart-disease prevention, Match rank-order list: One resident reflects on the dos and donts, New CPT code for COVID-19 testing: What you should know, CPT code descriptors (long, medium, and short). The association also released CPT codes for two antigen tests for the COVID-19 virus (87426 and 87811), and revised the code descriptors for CPT codes 87301-87430 to clarify proper reporting for antigen tests read by a machine. If the specimen is prepared by your office and sent to an outside lab, report the specimen collection code . For additional quantities, please contact [emailprotected] Further updates to these documents will only occur when there are additional modifications to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) codes other than vaccines. Administration fees for in-network providers will be based on contracted rates. CMS currently pays providers for the use of CPT codes 87635, 86769, and 86328, as well as Healthcare Common Procedure Coding System (HCPCS) codes U0001 and U0002. Information provided by the American Medical Association does not dictate payer reimbursement policy, and does not substitute for the professional judgement of the practitioner performing a procedure, who remains responsible for correct coding. Headline These CPT codes are unique for each coronavirus vaccine as well as administration codes unique to each such vaccine. If you are a care provider collecting the specimen for the COVID-19 test, please use the following codes for the applicable scenarios: Step 1. All rights reserved. However, if collected in the office and transported to the laboratory, CPT code 99000 can be billed: There are three codes for COVID-19 testing: 87635 is designed to detect the COVID-19 virus and effective March 13, 2020, and 86328 and 86769 will be used to identify the presence of antibodies to the COVID-19 virus and are effective April 10, 2020. All rights reserved. When the patient presents to the physicians office with symptoms of the coronavirus, the physician should bill the appropriate evaluation and management code consistent with the level of history, exam and medical decision-making made. 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. Our guidance continues to be informed by the American Medical Association and their CPT code experts. Last update: February 1, 2023, 4:30 p.m. CT. Additionally, the JAMA Network has a comprehensive overview of the coronavirusincluding epidemiology, infection control and prevention recommendationsavailable on itsJN Learning website. 0 I'm not sure what comprises your rapid test. You can check with the lab if you don't know. Network physicians are required to use a network laboratory. CPT code for rapid covid test. The new Category I codes and long descriptors are: 87636: Infectious . [Covid-19 Provider Update: Lab Billing for Coronavirus Test], [How should labs bill for the Coronavirus (COVID-19) test? <>/Metadata 1757 0 R/ViewerPreferences 1758 0 R>> I work for a Family practice and we currently do PCR COVID swabs that are sent out to a lab. CPT/ HCPCS Code Laboratory Code Long Descriptor Target 1. CPT Copyright 2021 American Medical Association. Patient presents for an office visit, urgent care visit or emergency room visit. A resident has guidance to help navigate the Supplemental Offer and Acceptance Program (SOAP). The latest Updates and Resources on Novel Coronavirus (COVID-19). %%EOF The AMA promotes the art and science of medicine and the betterment of public health. Category I and Proprietary Laboratory Analyses (PLA). CPT Assistant, the official source for CPT coding guidance, has issued a special edition with advice on severe acute respiratory syndrom coronavirus laboratory testing, including antigen testing. I found out it is for the Lucira all in one kit for home use but it is being used as a point of care test in the office. CPT Assistant is providing fact sheets for coding guidance for new SARS-CoV-2 (COVID-19)-related testing codes. Answer: Code 87635 is available effective imme-diately in the CPT code set and available for reporting beginning March 13 . Along with releasing the standard code descriptor PDF, we are also releasing an easy to use Excel file of just the SARS-CoV-2-related CPT codes. A breakthrough in coronavirus antigen testing could become part of the broader solution for the widespread testing shortages. We will reimburse COVID-19 testing in accordance with applicable law, including the CARES Act. 0. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Review and download the full CPT code descriptor release. 0 UnitedHealthcare Preferred Lab Network providers meet higher standards for access, cost, quality and service standards. We have sought guidance and input from AMA CPT committee in the development of all billing scenarios. The 2023 American Medical Association Medical Student Advocacy Conference (MAC) will be held March 2-3, 2023. COVID-19 FAQ: Your pressing questions answered, AMA president speaks on preparing physicians for COVID-19, JAMA Network: Coronavirus disease 2019 (COVID-19). We use cpt 87635 for billing. For more information or to answer questions, submit a ticket. The American Medical Association (AMA) has created a tool to help select the appropriate CPT code for the type and dose of vaccine that is being administered. Assign code U07.1, COVID-19, for a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, a positive COVID-19 test result or a presumptive positive COVID-19 test result. For more on the new codes and other recent changes to the CPT code set, see the latest, Updates and Resources on Novel Coronavirus (COVID-19), Institute for Diversity and Health Equity, Rural Health and Critical Access Hospitals, National Uniform Billing Committee (NUBC), AHA Rural Health Care Leadership Conference, Individual Membership Organization Events, The Important Role Hospitals Have in Serving Their Communities, CMS summarizes the status of certain COVID-19 flexibilities after May 11, FDA authorizes first over-the-counter test for both flu and COVID-19, DEA proposes new telehealth prescribing limit for certain controlled medications, Supporting Todays Workforce as We Develop Solutions for the Future, Campaign releases new toolkit to promote flu, COVID-19 vaccination, GE: Contrast media supplies returning to normal after shortage, American Organization for Nursing Leadership. 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I codes and long descriptors are: 87636: infectious on Novel coronavirus ( COVID-19 ) in! Reports test results including the CARES Act physician order and patient specimen for testing and vaccine administrations the correct for!