3 New Codes for Infectious-Agent Detection



The latest changes to the CPT® code set will help clinicians distinguish seasonal infections from COVID-19 in their reporting.

Three new CPT® codes have been created, Oct. 6, that will allow clinicians to distinguish the tests for influenza A, influenza B, and respiratory syncytial virus (RSV) that include SARS-CoV-2 from those that don’t. The new codes, along with associated parenthetical note changes, new guidelines, 40 code revisions, and one code deletion (87450), are effective immediately.

The Newest Members of the Family

The CPT® Editorial Panel has accepted:
87636 Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique; severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

Use 87636 to report combined respiratory virus multiplex testing for SARS-CoV-2 with influenza types A and B.

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

Use 87637 to report combined respiratory virus multiplex testing for SARS-CoV-2 with influenza types A and B, and RSV.

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

Use 87811 to report antigen detection of SARS-CoV-2 by direct optical (i.e., visual) observation.

Subsequent Guideline Changes and Code Revisions

Parenthetical note revisions for 86317 Immunoassay for infectious agent antibody, quantitative, not otherwise specified direct you see 83516, 83518-83520 for immunoassay techniques for non-infectious agent antigens; 87301-87451 for infectious agent antigen detection by immunoassay technique; and 87802-87899 for infectious agent antigen detection by immunoassay technique with direct optical observation.

New Microbiology guidelines and revised codes 87301-87451 correct and clarify reporting of infectious agent antigen studies using immunofluorescent technique, direct optical observation, and single-step vs. multiple-step techniques.

2 New Laboratory Codes, Too

Two new proprietary laboratory analyses (PLA) codes have also been established:
0240U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected
0241U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected

These tests, performed in the office by a physician or other qualified healthcare professional, employ the same cartridge and the assay is performed with or without RSV. Code selection is based on the number of targets tested. Refer to revised Appendix O in CPT® for the procedure’s proprietary name and clinical laboratory or manufacturer.

Download the CPT® Assistant Special Edition: October Update from the AMA website for more guidance and coding examples for these Oct. 6 changes.

History of Code Changes in 2020

It’s been a busy year for the CPT® Editorial Panel. As shown in the table below, many new codes have been created to accommodate data reporting for COVID-19-related tests and PLAs.

*Parent code 87301 and child code 87426 were revised in the Oct. 6 update to add “fluorescence immunoassay [FIA]” and to delete “multiple-step method.”

The AMA says that these changes will continue to be valid and active after the public health emergency declaration is lifted. The Centers for Medicare & Medicaid Services had not yet added the newest codes to the Clinical Laboratory Fee Schedule 2020 Quarter 4 release at press time.

As many of these code changes will not appear in the 2021 CPT® code book, coders will need to be diligent about manually updating their reference materials, or rely on coding software, which can be updated throughout the year.

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