Over the past several months, as the COVID-19 pandemic has raged on, the American Medical Association (AMA) has expedited the approval and release of CPT® codes to enable reporting of the various testing methodologies that have become available. The CPT® Editorial Panel convened a special meeting to approve additional codes specific to laboratory testing for COVID-19 and published four new codes last month. These CPT® codes address the ongoing need to report coronavirus testing and include two new Category I codes and two Proprietary Laboratory Analyses (PLA) codes.
Capturing Coronavirus Testing
Coronavirus antibody testing is used to determine if a person has had a past COVID-19 infection, even if they have never experienced any symptoms. This is done by verifying whether their body has created antibodies against the virus to help fight the infection. As science moves from determining who is currently infected to who has had the infection (antibody testing), the next step in the fight against COVID-19 is to determine who has mounted neutralizing antibodies against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus.
While the AMA has established CPT® codes for antibody testing — 86328 and 86769 — the existing codes do not capture the use of tests that determine whether the antibodies present in a patient can directly block the infection of cells. Thus, new codes were created and released for reporting these neutralizing antibody tests specifically.
New Codes Already in Effect
The CPT® Editorial Panel published the following two codes, effective Aug. 10, 2020, for reporting the laboratory tests that determine if the antibodies present can block COVID-19 viral infection:
- 86408 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen
- 86409 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); titer
The AMA also released the following new codes for proprietary laboratory analyses to detect SARS-CoV-2, effective Aug. 10, 2020:
- 0225U Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected,
- 0226U Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum
You can find these two codes in the Pathology and Laboratory section of your code book, as well as in Appendix O, which lists the new PLA codes, their descriptors, and the procedure’s proprietary names. To report a PLA code, the analysis performed must fulfill the code descriptor and must be the test represented by the proprietary name listed in Appendix O.
“New code 0225U describes infectious agent detection by nucleic acid (DNA and RNA) by amplified probe technique through polymerase chain reaction and electrochemical detection that generates a result of detected or not detected for each of the analytes. Code 0226U describes a high-throughput quantitative blocking ELISA assay to assess the patient’s viral neutralization capacity to SARS-CoV-2.”
CPT® Assistant Special Edition: August Update
Expansion of Coronavirus-Related Codes
The four new codes add to the AMA’s growing list of coronavirus-related codes that have been approved and published for the 2021 code set, including:
- Code 87635 to report infectious agent detection by nucleic acid (DNA or RNA); SARS-CoV-2 (Coronavirus disease [COVID-19]), amplified probe technique
- Code 86318 to report immunoassay for infectious agent antibody(ies) and to be a parent to 86328, which is used to report single step antibody testing for SARS-CoV-2
- Code 86769 to report multiple-step antibody testing for SARS-CoV-2
- PLA code 0202U to report the BioFire® Respiratory Panel 2.1 (RP2.1) test
- Code 87426 to report infectious agent antigen detection of SARS-CoV and SARS-CoV-2 by immunoassay technique
New Administrative MAAA Codes
For the October update of the Hospital Outpatient Prospective Payment System (OPPS), the AMA CPT® Editorial Panel established the following two new multianalyte assays with algorithmic analyses (MAAA) codes, effective Oct. 1, 2020:
- 0015M Adrenal cortical tumor, biochemical assay of 25 steroid markers, utilizing 24-hour urine specimen and clinical parameters, prognostic algorithm reported as a clinical risk and integrated clinical steroid risk for adrenal cortical carcinoma, adenoma, or other adrenal malignancy
- 0016M Oncology (bladder), mRNA, microarray gene expression profiling of 209 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as molecular subtype (luminal, luminal infiltrated, basal, basal claudin-low, neuroendocrine-like)
CMS revised MLN Matters Article MM11937 — Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services — on Aug. 24, 2020, to include the additional COVID-19 codes 86408, 86409, 0225U, 0226U, effective Aug. 10, 2020, and codes 0015M and 0016M, effective Oct. 1, 2020. The change request (CR) release date, transmittal number, and link to the transmittal also changed. All other information remains the same.