Reimbursement details have not yet been established.
The American Medical Association (AMA) CPT® Editorial Panel has made adjustments to one code and introduced two new codes to enhance the specificity of serology laboratory testing.
These codes, released on April 10, are immediately applicable. Reimbursement arrangements for the Centers for Medicare & Medicaid Services (CMS) are pending, and providers are advised to reach out to commercial carriers for information regarding reimbursement.
CPT code 86318 has been modified to incorporate testing for multiple infectious agent antibodies, utilizing a single-step method (e.g., reagent strip). The two new codes are 86328 and 86769. CPT code 86328 is a subcode of CPT code 86318 and specifically pertains to severe acute respiratory distress coronavirus (SARS-CoV2) (COVID-19) testing. There is an instructional note advising the use of CPT code 86769 for COVID-19 testing employing the multiple-step method, and CPT code 86328 for the single-step method.
An illustrative case for CPT code 86328 involves a 67-year old woman with a medical history of diabetes and hypertension, who presents at the emergency department with a five-day history of a non-productive cough and a low-grade fever. A COVID-19 antibody test using a reagent strip is requested, and the patient’s blood or serum is collected.
In the case of CPT code 86769, consider a 68-year old male with coronary artery disease, a previous aortic valve replacement, and lymphoma, who arrives at the emergency department with a six-day history of malaise, a non-productive cough, and a low-grade fever. COVID-19 IgG and IgM antibody tests are ordered, and both serum and plasma are collected.
Below are questions and answers associated with these new codes:
- What distinguishes CPT code 87635 (another recently introduced CPT) from these new codes? 87635 was designed for respiratory specimens, whereas the new codes are intended for serology testing.
- If a reagent strip provides analysis for two antibody classes using a single-step method, should 86328 be reported twice? No, CPT code 86328 should be reported once per reagent strip.
- In the event of using two reagent strips in two separate single-step assays, should 86365 be reported for each assay? Yes, CPT code 86328 should be reported for each reagent strip. Optionally, modifier -59 may be added to the second code to indicate that separate tests were conducted.
