The American Medical Association (AMA) updated Current Procedural Terminology (CPT) to enable proper COVID-19 coding and billing of antigen tests performed on patients suspected of having the novel coronavirus.
CPT codes have been developed to report immunizations against the novel coronavirus (SARS-CoV-2, also known as COVID-19). These CPT codes are unique to each coronavirus vaccine, as are the administration codes for each one. The new CPT codes clinically differentiate each coronavirus vaccine for improved tracking, reporting, and analysis, allowing for data-driven planning and allocation.
Antigen tests are increasingly being used in the healthcare industry to test patients for COVID-19. The FDA approved Quidel Corporation's Sofia 2 SARS Antigen FIA for testing in high and moderate complexity laboratories certified Clinical Laboratory Improvement Amendments, as well as point-of-care testing by facilities operating under a CLIA Certificate of Waiver.
Antigen tests distinguish themselves from other diagnostic tests by determining whether a patient has previously had COVID-19 and whether they have antibodies against the novel coronavirus. They are a different type of serology test that has gained popularity in the fight against COVID-19 due to diagnostic test shortages.
AMA has already developed and approved CPT codes for other COVID-19 antibody serological tests, including:
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])
Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
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 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.
According to Susan R. Bailey, MD, AMA president
“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.”
With the approval of new CPT codes, providers, clinical laboratories, and other healthcare stakeholders were able to more accurately report and track COVID-19 cases. Additionally, the codes enabled CMS and other payers to reimburse providers for performing COVID-19 tests. CPT codes 87635, 86769, and 86328, as well as Healthcare Common Procedure Coding System (HCPCS) codes U0001 and U0002, are reimbursed by CMS.
As the COVID-19 public health crisis continues, private payers' policies are being updated. Keep visiting the page to learn more about the most recent policy changes affecting billing and coding for COVID-19.