New CPT Code Expands COVID-19 Coding, Billing to Antigen Tests

The American Medical Association (AMA) recently updated Current Procedural Terminology (CPT) to enable proper COVID-19 coding and billing of antigen tests performed on patients suspected of being infected with the novel coronavirus.

Unveiled on Friday, 87426 is a Category I CPT code approved by the CPT Editorial Panel late last week during a special meeting. The long descriptor is:

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

The new code is meant for “use as the industry standard for accurate reporting and tracking of antigen tests using immunofluorescent or immunochromatographic technique for the detection of biomolecules produced by the SAR-CoV-2 virus,” the AMA stated in the release.

Although the code is not specific to the novel 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.

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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.

AMA has already developed and approved CPT codes for other serological tests for COVID-19 antibodies, including:

• 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])

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.

“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,” Susan R. Bailey, MD, AMA president, on Friday. “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.”

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 Healthcare Common Procedure Coding System (HCPCS) codes U0001 and U0002.

CMS has yet to release Medicare reimbursement rates for the newest code, 87426.

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.