We heard the AMA created another new COVID lab code, CPT 87428. When should we be reporting this code?
On November 10, 2020, the AMA announced the creation of an additional COVID-19 related lab code, CPT 87428.
87428: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B.
Per the AMA CPT Assistant article linked below, CPT code 87428 should be reported for laboratory tests that utilize multiplex immunoassay antigen testing techniques to detect the following 3 viral targets: SARS-CoV-2 (COVID-19), influenza A and influenza B. Per the AMA, CPT 87428 is effective immediately.
Code selection between existing CPT codes 87636, 87637 and new CPT code 87428 is dependent on the specific testing methodology used. As noted above, CPT code 87428 should be reported for tests that utilize multiplex immunoassay antigen techniques. CPT codes 87636 and 87637 would continue to be reported for tests that utilize multiplex amplified probe techniques. We would advise discussing with your laboratory department to assess which techniques are being utilized at your facility.
As always, we caution that there will be a delay for both Medicare and private payers to update their claims processing systems to accept this new code. 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 for Code 87428: