Learn about the new COVID-19 Tests CPT Codes 87426, 86328 and 86769 for 2020-2021 to submit your medical billing claims without rejection. American Medical Association (AMA) has updated Current Procedural Terminology (CPT) with COVID-19 billing coding.

The new procedure codes cover antigen tests for novel coronavirus infection diagnosis. CPT Editorial Panel during a special meeting approved 87426 CPT code of Category-I.

AMA stated in the release that the new code is used as the industry standard for accurate reporting and tracking of antigen tests using the immunofluorescent or immunochromatographic technique for the detection of biomolecules produced by the SAR-CoV-2 virus. For quick reference, the new Category I CPT codes and long descriptors are:

87426 COVID-19 Infectious agent antigen SARS-CoV-2 detection

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]).

6769 and 86328 Coronavirus Antibody Test Codes

AMA has already approved 2 CPT codes for COVID-19 antibodies serological tests:
  • 86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, 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])

New COVID-19 CPT Codes 87426, 86328, 86769 for Billing

New CPT codes approved during the special meetings have enabled providers, clinical laboratories, and other healthcare stakeholders to more accurately report and track cases of COVID-19. The codes have also allowed CMS and other payers to reimburse providers for performing COVID-19 tests. CMS currently pays providers for the use of CPT codes 87635, 86769, and 86328, as well as the Healthcare Common Procedure Coding System (HCPCS) codes U0001 and U0002. However, the Medicare reimbursement rates for the newest code, 87426 is not yet announced by CMS.

Although the 87426 CPT code is not specific to the coronavirus, the association points out in official CPT coding guidance. The code can be used for an immunoassay that detects antigenic proteins for either SARS-CoV or SARS-CoV-2.

The healthcare industry is increasingly using antigen tests as a quicker and simpler means to test patients for COVID-19.

The FDA approved the first emergency use authorization for a COVID-19 antigen test in early May. The agency gave the green light to Quidel Corporation’s Sofia 2 SARS Antigen FIA for testing in high and moderate complexity laboratories certified Clinical Laboratory Improvement Amendments, as well as for point-of-care testing by facilities operating under a CLIA Certificate of Waiver.

Antigen tests notably differ from other diagnostic tests by determining whether a patient had COVID-19 in the past and antibodies against the novel coronavirus. They are another type of serology test, which has become popular in the fight against COVID-19 amid diagnostic test shortages.

The leading medical association also created CPT code 87635 to enable COVID-19 coding and billing for molecular testing of the novel coronavirus. The CPT code represents infectious agent detection by the nucleic acid.

AMA has had to convene special meetings since the outbreak of the pandemic to create COVID-19 coding and billing practices to align with medical advancements made to quickly and effectively respond to the virus.

Susan R. Bailey, MD, AMA president, said:
The new CPT code for antigen testing to detect the coronavirus is the latest in a series of CPT codes developed in rapid response to the pandemic. Moving quickly during this crisis to meet the medical coding needs of the health care industry has enhanced the reporting of innovative tools now available to advance medicine's overarching goals of reducing the COVID-19 disease burden, improving health outcomes and reducing long-term care costs.
However, per the standard early release delivery process for CPT codes, providers will need to manually upload descriptors for new COVID-19 codes into their EHR systems. The CPT codes will arrive as part of the complete CPT code set in the data file for 2021 later this year.

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