Has the AMA created new CPT codes for laboratory tests that simultaneously screen for COVID-19, influenza and respiratory syncytial virus?

Yes. On October 6, 2020, the AMA announced the creation of 2 new CPT codes (87636, 87637) and 2 new PLA codes (0240U, 0241U) that describe laboratory tests that can distinguish between COVID-19, influenza A/B, and RSV. Per the AMA, tests that evaluate these four viruses would have historically been reported using CPT code 87631. However, due to the unprecedented nature of the pandemic, the CPT Editorial Panel decided the creation of new codes, specific to SARS-CoV-2 rather than coronaviruses in general, was warranted. In addition, the AMA created 1 new CPT code (87811) for reporting antigen detection of COVID-19 by direct optical observation.

For your convenience we have provided the long descriptions for each of the new CPT and PLA codes below.

87636: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

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

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])

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

It is important to note that both PLA codes, 0240U and 0241U, are specific to the Cephid Expert Express SARS-CoV-2/Flu/RSV testing system. Code selection between 0240U and 0241U is dependent on the total number of targets tested using this system. PLA code 0241U would be reported if all targets (COVID, flu, RSV) are tested; if only COVID and flu targets are tested, report PLA code 0240U.

For additional coding guidance as well as relevant clinical examples, please review the CPT Assistant Article linked below.

As always, we caution that there will be a delay for both Medicare and private payers to update their claims processing systems to accept these new codes. To avoid claim rejections and denials, we would advise checking with your individual MACs and/or commercial payers prior to claim submission to confirm code availability.

CPT Assistant Article COVID-19 October Update:
https://www.ama-assn.org/system/files/2020-10/cpt-assistant-guide-coronavirus-october-2020.pdf