Update: New CPT® Category I Code Released for SARS-CoV-2 (Coronavirus Disease [COVID-19]) Testing

Effective March 13, 2020, the American Medical Association (AMA) has approved and released a new CPT code to report testing for COVID-19 after holding a special meeting of the CPT Editorial Panel to respond to the rapidly evolving concerns surrounding testing for this novel coronavirus. The goal with the expedited release of this new code is to “help efficiently report and track testing services related to SARS-CoV-2 and streamline the reporting and reimbursement for this test in the United States.”

87635Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

Code 87635 is available for reporting as of March 13, 2020, and should be used to report testing done on or after that date. Providers will need to contact their payers for policies regarding any retroactive billing of tests performed prior to March 13.

Guidelines for Use

The same guidelines we currently follow for reporting laboratory microbiology tests also apply to code 87635. In other words, reporting SARS-CoV-2 testing follows the same guidelines as reporting other codes for infectious agent detection.

The CDC has recommended that both nasopharyngeal and oropharyngeal swabs should be collected to test for SARS-CoV-2. If requested to perform tests for the same virus, on separate specimens, for the same patient, on the same date of service, current CPT guidelines state that two units of code 87635 should be reported with modifier 59 appended to the second unit of service. Modifier 59 represents that a separate, distinct service was performed.

Other codes do currently exist in the microbiology section of CPT that contain coronavirus in their descriptions. Specifically, codes 87631-87633 are available for the detection of multiple respiratory viruses with a multiplex technique. Additionally, PLA codes 0098U-0100U are available for the detection of multiple respiratory viruses using a specific manufacturer’s test. Where code 87635 is different, according to CPT Assistant Special Edition, Volume 30, is that it is specifically “for the detection of SARS-CoV-2 and any pan-coronavirus types or subtypes, and it can be reported with tests from multiple manufacturers using the stated technique.” That same Special Edition of CPT Assistant goes on to state that “there are no known restrictions” on reporting code 87635 with codes 87631-87633 or 0098U-0100U if performed on a separate assay. As with all laboratory tests, the codes selected and reported should be based on the service(s) provided and describe those services as accurately as possible.

Relation to HCPCS Codes

Previously, the Centers for Medicare and Medicaid Services (CMS) had developed and released two new HCPCS codes to report SARS-CoV-2 testing on Medicare claims.

U0001  CDC 2019 novel coronavirus (2019-nCoV) real-time RT-PCR diagnostic panel

U0002  2019-nCoV coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC

Code U0001 is to be used when testing patients for SARS-CoV-2 with CDC tests, while code U0002 is to be used when performing non-CDC tests for SARS-CoV-2. Be sure to follow individual payer policies as to whether the CPT code (87635) or a HCPCS code (U0001, U0002) should be reported. Remember that, on the same claim, both CPT and HCPCS codes should not be reported.  Medicare has stated in MLN Connects 2020-02-20 that it will be able to accept these codes beginning April 1, 2020, for dates of service on or after February 4, 2020.

Stay Informed

The information released by the AMA regarding this new code, including the CPT Assistant Special Edition, can be found HERE.

This situation is evolving rapidly. Guidance is current at the time of publication and may be subject to change as the situation continues to progress. It is important to continue to check sources such as the Centers for Medicare and Medicaid Services and the American Medical Association for any updates that are released.

A note about names: The official name of this virus, as released by the World Health Organization, is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19) is the name for the disease caused by the virus.