AMA Adds CPT Codes for Multi-Virus Tests for COVID-19, Flu

In response to the COVID-19 pandemic, the American Medical Association (AMA) is adding two new codes to the Current Procedural Terminology (CPT) code set. The codes are for multi-virus tests that can detect both COVID-19 and other viruses, like the flu.

The new Category I codes and long descriptors are:

• 87636: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique
• 87637: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

The CPT Editorial Panel approved the new codes for immediate use.

Providers would normally use CPT code 87631 to report a test panel that detects the flu and respiratory syncytial virus (RSV) infections. But the public health emergency has created a need for clinicians to rapidly distinguish these virus from COVID-19, the AMA states in new coding guidance.

Multi-virus tests could help boost testing capacity for the healthcare industry, which continues to face a shortage of testing supplies, according to Susan R. Bailey, MD, AMA president.

“Two of the newly approved codes report nucleic acid assays that allow a single test to simultaneously detect the novel coronavirus and a combination of common viral infectious agents, including influenza A/B and respiratory syncytial virus,” Bailey said in an announcement earlier today. “Concurrent detection promises to conserve important testing resources, allowing for ongoing surveillance of influenza while testing for the novel coronavirus.”

The announcement also highlighted the revision of CPT codes 87301 through 87430, which report tests for infectious agency antigen detection by the immunoassay technique. Effective immediately, code descriptors for the impacted CPT codes no longer have the undefined term “multi step method.”

“The revision clarifies the proper reporting for antigen tests that are read by a machine, as compared to those which can be visually interpreted without a machine. This revision affects the newly developed descriptor for CPT code 87426,” AMA stated in the announcement.

In accordance with the revision, the CPT Editorial Panel also approved a new Category I code to report infectious agent antigen detection by immunoassay with direct visual observation.

The CPT code and long descriptor are:

87811: Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

The new CPT codes join the ranks of a growing list of new COVID-19-related changes to the code set.

Since the start of the pandemic, the CPT Editorial Panel has approved about a dozen new CPT codes to account for changes in medical services and diagnostics in light of COVID-19. The codes cover a wide range of COVID-19 testing, including by nucleic acid and for antibody and antigen detection. A code approved in September (99072) also accounts for the additional supplies and clinical staff time required to prevent the spread of the virus.

Additionally, the Panel has added several codes to the Proprietary Laboratory Analyses (PLA) code set, including the most recent addition of codes 0240U and 0241U for the detection of COVID-19, influenza A, and influenza B. Another new code (0240U) also detects RSV.

The latest coding guidance from AMA also includes revisions to Immunology guidelines. The revisions “correct and clarify reporting of infectious agent antigen studies in the Microbiology subsection in the Pathology and Laboratory section of the CPT code set,” the guidance states.

AMA noted that, per the standard early release delivery process for new CPT codes, providers will need to manually upload the code descriptors into their EHR systems. New codes are typically included in the complete CPT code set in the data file for the new year. AMA released the data file for 2021 at the start of September.

For a complete list of CPT code set changes related to COVID-19 and coding guidance, click here.