Continuing their quick response as the COVID-19 pandemic evolves, the American Medical Association (AMA) held another special meeting of the CPT® Editorial Panel to address the immediate need for codes to report and track antibody testing specifically for SARS-CoV-2 (the virus that causes the disease COVID-19).
Effective April 10, 2020, the AMA has approved the addition of two new CPT codes to describe this antibody testing.
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])
As stated above, these codes were effective immediately upon their April 10, 2020 release for reporting SARS-CoV-2 antibody tests. For reimbursement, labs are directed to contact their payers for guidelines.
Guidelines for Use
The same guidelines we currently follow for reporting immunology tests also apply to codes 86328 and 86769. In other words, reporting SARS-CoV-2 antibody testing follows the same guidelines as reporting other codes for immunology. As a note, the guidelines in the immunology section of CPT were revised to include the new code 86328.
Code 86328 describes a single-step, qualitative or semiqualitative, method immunoassay for SARS-CoV-2. Meaning, a single testing device (i.e., a single reagent strip) is used to perform the test. Code 86328 would be reported once for a single strip that tests for one or multiple antibody classes, regardless of the number of classes tested for on the strip. If separate single-step assays need to be performed separately using multiple strips, code 86328 should be reported for each strip tested with modifier 59 to indicate separate, distinct tests were performed.
For testing performed using a point-of-care system, the majority are a single-step method and would be most appropriately reported with code 86328. Code 86769 describes an antibody test performed using a multiple-step method.
Clinical examples and procedure descriptions for each code 86328 and 86769 can be found in a special edition of the AMA CPT Assistant. The AMA does caution that “due to the early stage for these tests, clinical indications are subject to further refinement as knowledge of the novel coronavirus evolves.” It is important to continue to monitor updates as they are released.
In addition to the new codes released, the description of code 86318, the parent code for 86328, was revised as follows:
86318 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip);
New parenthetical notes have also been added to the immunology section of CPT directing readers to the correct codes for single-step and multiple-step testing methods, as well as a note under code 86635 directing readers to these new codes for SARS-CoV-2 antibody testing.
These updates will be published in the 2021 CPT Manual.
The information released by the AMA regarding these new codes, 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.