During the exam, the physician observes swollen and red tonsils. 2023 Laboratory Corporation of America Holdings. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work recommending their use. 2021 Laboratory Corporation of America Holdings and Lexi-Comp Inc. All Rights Reserved. CONTENTS: 25 Test Cassettes, 25 Sterile Swabs, 25 Extraction Reagent Capsules, 1 Positive Control Swab, 1 Negative Control Swab, 1 Procedure Card, 1 Instructions for Use. Includes: influenza A (non-novel), influenza B, influenza C. Vignette. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. Some articles contain a large number of codes. The Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV assay is a rapid, real-time RT-PCR test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A, influenza B, and respiratory syncytial virus (RSV) viral DNA in either nasopharyngeal swab, nasal swab or nasal wash/aspirate specimens collected from individuals suspected of respiratory viral infection . Color-coded control swab packaging for easy positive/negative . used to report this service. "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," said AMA . Room temperature (15C to 30C/59F to 86F) Internal controls. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). Clinical significance: Influenza is an acute viral disease that is seasonal in incidence, occurring in the colder months. Unless specified in the article, services reported under other FDA) now requires that all Rapid influenza diagnostic tests (RIDTs) achieve 80% or higher sensitivity compared with RT-PCR. All rights reserved. Some older versions have been archived. Testing schedules may vary. We code 87804 and 87804-59 if both A and B are tested and results documented. In some cases, additional time should be To avoid the overuse of antibiotics and the potential risk of antibiotic resistance, point of care providers should consider testing patients prior to prescribing treatment for a bacterial or influenza infection. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. Information for Clinicians on Rapid Diagnostic Testing for Influenza. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. There are multiple ways to create a PDF of a document that you are currently viewing. PCR confirmed positive and negative clinical samples were screened with the Panbio COVID-19/Flu A&B Rapid Panel test, an lateral flow strip immunoassay for nucleocapsid proteins of CoV-1, Influenza A and B. Rapid, one-step lateral flow test that differentiates between influenza virus A and B within 15 minutes. The ability to use just one swab during a healthcare visit, rather than four separate tests, aims to decrease discomfort, lessen cost demands for doctors and lab workers . CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. ONLY IF NO MORE DESCRIPTIVE MODIFIER IS AVAILABLE, AND THE USE OF MODIFIER -59 BEST EXPLAINS THE CIRCUMSTANCES, SHOULD MODIFIER -59 BE USED. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. No. RT-PCR or other amplification methods to detect viral nucleic acids, Results available in < 24 hours (often in less than 2-4 hours), Detects from 1-2 to up to 20 respiratory pathogens from 1 specimen. The AMA is a third party beneficiary to this Agreement. Download AMA Connect app for Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. The Medicare National Limit amount* is $16.36. R5. COVID-19/Flu A&B Diagnostic Test. Streamlines laboratory operations. THIS MAY REPRESENT A DIFFERENT SESSION OR PATIENT ENCOUNTER, DIFFERENT PROCEDURE OR SURGERY, DIFFERNET SITE OR ORGAN SYSTEM, SEPARATE INCISION/EXCISION, SEPARATE LESION, OR SEPARATE INJURY (OR AREA OF INJURY IN EXTENSIVE INJURIES) NOT ORDINARILY ENCOUNTERED OR PERFORMED ON THE SAME DAY BY THE SAME PHYSICIAN. The document is broken into multiple sections. required field. Do not freeze specimens. Code 87804 (infectious agent antigen detection by immunoassay with direct optical observation; influenza) is appropriate for these tests, which are Clinical Laboratory Improvement Amendments (CLIA) waived (ie . will not infringe on privately owned rights. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. Accessed 4/27/21. 87636: Infectious agent detection by nucleic acid (DNA or RNA); severe . AHA copyrighted materials including the UB‐04 codes and used to report this service. The revision clarifies the proper reporting for antigen tests that are read by a machine, as compared to those which can be visually interpreted without a machine. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. not endorsed by the AHA or any of its affiliates. You can collapse such groups by clicking on the group header to make navigation easier. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. The AMA does not directly or indirectly practice medicine or dispense medical services. "JavaScript" disabled. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or Complete absence of all Revenue Codes indicates Answers to questions on CPT coding and content are available from the CPT Network. Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. Similarly, tests (and CPT codes) for which there are no accompanying ICD-10 codes in the associated Billing and Coding Article will require registration with MolDX . If a CLIA-waived test is performed, the -QW modifier should be reported for the waived test. Immunofluorescence (IF) - Direct (DFA) or Indirect (IFA) Fluorescent Antibody Staining (antigen detection): If a rapid antigen test is performed and then confirmed using PCR, the second test may require the -59 modifier. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; You need modifer -QW for Medicare patients. The suggested*** CPT codes are: Influenza A: 87804 . Please visit the. 7500 Security Boulevard, Baltimore, MD 21244. The HOD speakers welcome comments for reports under development for the upcoming Interim and Annual Meetings. preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. J Clin Microbiol. End User License Agreement: DISCLOSED HEREIN. If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. Complete absence of all Revenue Codes indicates Please help me in coding this. Draft articles are articles written in support of a Proposed LCD. Available FDA cleared tests as of August 2020. According to the FDA, in individuals with symptoms, the home test correctly identified 99.3% of negative and 90.1% of positive Influenza A samples, 100% of negative and 88.3% of positive COVID-19 . Read the House of Delegates (HOD) speakers' updates for the 2023 Annual HOD Annual Meeting. Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Shell vials or equivalent multiwell plate cell culture; identification (additional CPT codes/charges will apply) if culture results warrant. If your session expires, you will lose all items in your basket and any active searches. Use modifier 59 when separate results are reported for different species or strains, same laboratory test on the same day to obtain subsequent test results. endstream endobj startxref End User Point and Click Amendment: As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. Background. Draft articles are articles written in support of a Proposed LCD. Room Temperature. Influenza A Virus, Influenza B Virus: Reflex Test(s) (Influenza A Subtype by Polymerase Chain Reaction (PCR) and Influenza B Subtype by Polymerase Chain Reaction (PCR): results not reported to facility but will be reported to IDPH and CDC.) The UW Clinical Virology Laboratory in the Department of Laboratory Medicine and Pathology incorporates the modified FDA approved Panther Fusion Flu A/B/RSV assay for the rapid detection and differentiation of human influenza A/B, and respiratory syncytial virus (RSV) using real-time PCR. Under Article Text subheading Reference the access date was . Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Source: Regenstrief LOINC Part Description . Reference: Centers for Disease Control and Prevention. $7,252.00 / Case of 12 PK. The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. Also, you can decide how often you want to get updates. Complete absence of all Bill Types indicates Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. Accessed 4/27/21. COVID-19/Flu A&B test is intended to aid in the rapid differential diagnosis of Influenza A, B, and SARS-CoV-2 viral infection. The CMS.gov Web site currently does not fully support browsers with If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. All rights reserved. article does not apply to that Bill Type. When we billed Medicare for both of these CPTs they were denied . Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). For swabs in saline: OP, NP or anterior nasal swabs may be placed in 1 to 3 mL of sterile saline (0.85 to 0.9%) in a sterile screw cap container. Reference: Centers for Disease Control and Prevention. Follow manufacturers instructions, including handling of respiratory specimens, as described in the device package insert. No, the large language model cannot deliver medical care. 2037665 All Rights Reserved. Learn more about the process with the AMA. Reproduced with permission. Rapid influenza diagnostic tests (RIDTs) are immunoassays that can identify the presence of influenza A and B viral nucleoprotein antigens in respiratory specimens, and display the result in a qualitative way (positive vs. negative) (1). The update to the CPT code set was approved by the CPT Editorial Panel, the independent body convened by the AMA with authority to review and approve proposed additions and revisions to the CPT code set. The page could not be loaded. The performance characteristics of rapid influenza diagnostic tests vary widely. AMA SPS member Mary K. McCarthy, MD, discusses the activities and efforts of the Committee on Senior Physicians at the Oregon Medical Association. Centers for Disease Control and Prevention (CDC) recommendations: Use rapid diagnostic tests with high sensitivity and specificity. resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. You are using an out of date browser. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. The page could not be loaded. Also, you can decide how often you want to get updates. According to the EUA, it correctly correctly identified 99.3% of negative and 90.1% of positive flu A samples; 99.9% of negative flu B samples; and 100% of negative and 88.3% of positive COVID-19 . CPT code(s): 87635 (HCPCS: U0003. Nov 4, 2009. 10/24/2019. without the written consent of the AHA. This item is not returnable. 87811 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. However, please note that once a group is collapsed, the browser Find function will not find codes in that group. PPA* (versus an FDA-cleared influenza A and B molecular assay) A: 81.5%, B: 80.9%. announces CPT code for antigen tests in the CPT code approved for SARS-CoV-2 antigen testing. An asterisk (*) indicates a Article document IDs begin with the letter "A" (e.g., A12345). Follow manufacturers instructions, including handling of respiratory specimens, as described in the device package insert. Applications are available at the American Dental Association web site. The test is intended for use in the simultaneous rapid in vitro detection and differentiation of SARS-CoV-2, influenza A virus, and influenza B virus nucleocapsid protein antigen , but does not . (CPT) code(s) information for each test or profile. opportunity for Oseltamivir (Tamiflu) treatment for positive patients, Results available in approximately 2-4 hours, Article - Billing and Coding: Influenza Diagnostic Tests (A59055). Test code: 97636. CMS believes that the Internet is RT-PCR or other amplification methods to detect viral nucleic acids, Results available in < 24 hours (often in less than 2-4 hours), Detects from 1-2 to up to 20 respiratory pathogens from 1 specimen. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. MACs are Medicare contractors that develop LCDs and Articles along with processing of Medicare claims. of the Medicare program. Sofia 2 with Advance Result Technology (ART) delivers accurate, objective and automated results in as few as three minutes. A patient has had recent close exposure (this does NOT include eating cooked meat) to pigs or birds (including poultry) or other animals, and there is concern for infection with a novel influenza A virus. Billing & Coding. CPT/ HCPCS Code Laboratory Code Long Descriptor Target . Harmon MW, Kendal AP. What is the CMS suggested CPT code and National Limit for the Sofia Influenza A+B FIA?