Has CMS published the payment rates for the new COVID-19 antibody laboratory CPT codes 86769 and 86328? Are these codes retroactive for Medicare?
In prior notices and press releases CMS stated the reimbursement rates for COVID-19 antibody CPT codes 86769 and 86328 would be set by the individual MACs until national rates could be established through the annual laboratory meeting process. On May 19, 2020, CMS published publicly the rates each of the MACs have established for CPT codes 86769 and 86328. Per the “Medicare Administrative Contractor COVID-19 Test Pricing” document linked below the payment rate for CPT 86769 has been set at $42.13 and for CPT 86328 the rate will be $45.23.
In a separate MLN Special Edition bulletin, also released on May 19, 2020, CMS clarified that the retroactive effective dates for CPT codes 86769 and 86328 will be the date the codes were announced by the AMA. Meaning, CPT codes 86769 and 86328 are retroactively effective for dates of service on or after April 10, 2020 for Medicare claims.
Medicare Administrative Contractor COVID-19 Test Pricing:
MLN Special Edition May 19, 2020: