Four New CPT Codes to Report COVID-19 Laboratory Testing

by | Published on Aug 28, 2020 | Medical Coding

CPT Codes
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Four new codes have been introduced for coronavirus testing. This is in addition to the COVID-19 CPT code and description for testing came into effect on March 13, 2020, that our medical billing company had reported on.

Announcing the release of the four codes, the American Medical Association (AMA) stated that new codes had been created to streamline the novel coronavirus testing currently available on the United States market. According to the AMA’s August CPT Assistant special update, the two new Category I codes and two new PLA codes released on Monday, August 10, 2020, were effective immediately for use in reporting laboratory tests for COVID-19.

The new CPT codes are:

  • 86408 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen
  • 86409 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer
  • 0225U Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected
  • 0226U Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum

Prior to the release of these new codes, there were no CPT codes specifically for tests that measure a patient’s SARS-CoV-2 neutralizing antibodies. There were also no codes related to utilizing a cellular reporter system to measure live virus infection of cells in culture.

“As science moves from determining who is currently infected to who has had the infection (antibody testing), the next step during the COVID-19 pandemic is to determine who has mounted neutralizing antibodies against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus”, noted the AMA in its coding guidance document.

The COVID-19 antibody test is authorized by the U.S. Food and Drug Administration (FDA). Coronavirus antibody tests check the blood for antibodies, which may indicate if the person has had past infection with the virus that causes COVID-19. A person who tests positive for coronavirus antibodies may be protected from re-infection, but the CDC cautions that it is not known how much protection the antibodies may provide or how long this protection may last.

Coronavirus antibody tests play an important role in revealing the extent of the novel coronavirus in the general population and for identifying high-risk groups. According to the CDC, these tests can also help identify donors whose blood can be used to help patients fighting coronavirus.

Code 86408 allows reporting SARS-CoV-2 neutralizing antibody screen and code 86409 is for reporting SARS-CoV-2 neutralizing antibody titer. These new tests determine if antibodies present in a patient specimen can directly block infection of cells expressing the viral entry receptor on their surface.

Code 0225U describes infectious agent detection by nucleic acid (DNA and RNA) by amplified probe technique through polymerase chain reaction and electrochemical detection that generates a result of detected or not detected for each of the analytes. Code 0226U describes a high-throughput quantitative blocking ELISA assay to assess the patient’s viral neutralization capacity to SARS-CoV-2.

The new codes add to the AMA’s SARS-CoV-2 related CPT codes approved for the 2021 CPT code set, which includes:

  • 87635 to report 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 (effective March 13, 2020).
  • Revision of code 86318 to report immunoassay for infectious agent antibody(ies) and to be a parent to 86328; addition of code 86328 to report single step antibody testing for severe acute respiratory syndrome coronavirus 2; addition of child code 86769 to report multiple-step antibody testing for severe acute respiratory syndrome coronavirus 2; and revision of the Immunology guidelines (effective April 10, 2020).
  • PLA code 0202U to report the BioFire® Respiratory Panel 2.1 (RP2.1) test (effective May 20, 2020)
  • 87426 to report infectious agent antigen detection by immunoassay technique of SARS-CoV and SARS-CoV-2. Two new PLA codes (0223U and 0224U) were accepted for detection of SARS-CoV-2.

While code 86328 describes only the presence of antibodies, new codes 86408 and 86409 are used to report tests that determine if the antibodies present can block the COVID-19 virus infection, the AMA stated.

With the introduction of the new CPT codes for coronavirus testing, medical billing companies can help providers report more laboratory testing of the novel coronavirus on medical claims.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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