Download AMA Connect app for "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 . The CMS.gov Web site currently does not fully support browsers with Next video. The Sofia Influenza A+B FIA has been shown to detect cultured human isolates of H5N1; as with other rapid tests for influenza, the ability of the Sofia . The AMA does not directly or indirectly practice medicine or dispense medical services. damages arising out of the use of such information, product, or process. %PDF-1.6 % Methods: We systematically collected and analyzed our data regarding the use of a rapid diagnostic test for seasonal influenza A and B in patients with specific respiratory symptoms that sought medical services, during the time period from 01/01/2009 to 30/05/2009, from a network . "JavaScript" disabled. authorized with an express license from the American Hospital Association. All Rights Reserved (or such other date of publication of CPT). If a CLIA-waived test is performed, the -QW modifier should be reported for the waived test. Revenue Codes are equally subject to this coverage determination. An official website of the United States government. This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual. Do not use transport devices beyond their expiration date. Shaw MW, Arden NH, Maassab HF. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. 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". Reproduced with permission. Influenza Viruses Detected Influenza A Virus Subtypes Differentiated Other Respiratory Viruses Differentiated Approved Specimens 3 Test Time 4; High, Moderate: BioFire Diagnostics, LLC (Commercially Available) BioFire Respiratory Panel 2.1 (RP2.1) Nucleic Acid Detection: FILMARRAY 2.0 and FILMARRAY TORCH systems: Influenza A, Influenza B: A . End User Point and Click Amendment: recommending their use. The client will not be telephoned to approve this charge. * For positive Flu only or RSV only. You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. 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. Specify the exact specimen source/origin (eg, nasopharynx). 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 can collapse such groups by clicking on the group header to make navigation easier. You must log in or register to reply here. Officials and members gather to elect officers and address policy at the 2023 AMA Annual Meeting being held in Chicago, June 9-14, 2023. Editor's note: While this department attempts to provide accurate information and useful advice, third-party . will not infringe on privately owned rights. 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. 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. When community influenza activity is high and the rapid diagnostic test result is negative. You can use the Contents side panel to help navigate the various sections. CPT code for the rapid flu test. 87804-QW, infectious agent antigen detection by immunoassay with direct optical observation; influenza. Collect respiratory tract specimens as early in the illness as possible (within 3-4 days of illness onset). 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. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. The AMA does not directly or indirectly practice medicine or dispense medical services. Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). New aspects of influenza viruses. The performance characteristics of rapid influenza diagnostic tests vary widely. The Alinity m Resp-4-Plex assay was validated with nasopharyngeal swabs. Direct comparison of Alere i and cobas Liat influenza A and B tests for rapid detection of influenza virus infection. Each month, the Senior Physician Sectionhighlights membersand individualsto showcase their work and current efforts. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Information for Clinicians on Rapid Diagnostic Testing for Influenza. The codes are for multi-virus tests that can detect both COVID-19 and other viruses, like the flu. No. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. The code joins other COVID-19 testing codes already approved by the CPT Editorial Panel, an independent body convened by the AMA that has the sole authority to expedite the review of proposed changes and additions to the CPT code set. The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, Billing and Coding: Influenza Diagnostic Tests, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Less sensitive (50%-70%) and specific (90%-95%) compared to other methods and may require confirmation by. Influenza Type A and Type B. recommending their use. Description. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not In: Balows A, Hausler WJ, et al, eds. 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 code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. 0. Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. 2009;13(1):15-18. What is the CMS suggested CPT code and National Limit for the Sofia Influenza A+B FIA? "JavaScript" disabled. The document is broken into multiple sections. Rapid, one-step lateral flow test that differentiates between influenza virus A and B within 15 minutes. Applications are available at the American Dental Association web site. There are multiple ways to create a PDF of a document that you are currently viewing. 343 0 obj <>/Filter/FlateDecode/ID[<37EF32E039E8174080E7FA357BB6EB41>]/Index[323 30]/Info 322 0 R/Length 103/Prev 193612/Root 324 0 R/Size 353/Type/XRef/W[1 3 1]>>stream Turnaround time is defined as the usual number of days from the date of pickup of a specimen for 7500 Security Boulevard, Baltimore, MD 21244. 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. Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration In individuals with symptoms, the Lucira COVID-19 & Flu 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 . Under Article Title changed the title from "Influenza Diagnostic Tests" to " Billing and Coding: Influenza Diagnostic Tests". No fee schedules, basic unit, relative values or related listings are included in CPT. RIDTs usually involve inserting a swab into your nostril to get a sample. PPA* (versus an FDA-cleared influenza A and B molecular assay) A: 81.5%, B: 80.9%. Instructions for enabling "JavaScript" can be found here. The scope of this license is determined by the AMA, the copyright holder. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential 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". The May 2009 issue of CPT Assistant provided some guidance regarding this in the article, "Coding Brief: Rapid Influenza Virus A and B Testing (Code 87804)." The coding brief noted that direct optical observation "is a testing platform that yields a typi- Kidney disease can be prevented, and even reversed in its early stages. preparation of this material, or the analysis of information provided in the material. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. Rapid Test Kit McKesson Consult Infectious Disease Immunoassay Influenza A + B Nasal Swab / Nasopharyngeal Wash / Nasopharyngeal Aspirate Sample 25 Tests CLIA Waived. MODIFIER CODE 09959 MAY BE USED AS AN ALTERNATE TO MODIFIER -59. 87426 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]). 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. Information for Clinicians on Rapid Diagnostic Testing for Influenza. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. However, please note that once a group is collapsed, the browser Find function will not find codes in that group. COVID-19/Flu A&B Diagnostic Test. Current Dental Terminology © 2022 American Dental Association. The page could not be loaded. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or CMS takes big steps to fix prior authorization in Medicare Advantage and more in the latest Advocacy Update spotlight. This page displays your requested Article. CLIA waived; SOFIA Influenza rapid test demonstrated good specificity and low sensitivity compared with a nucleic acid test for influenza A, subtype H3, and for influenza B. SOFIA Influenza A + B test performed well in providing a rapid diagnosis, however, confirmatory molecular testing is recommended for negative test results. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. Data for the 2017 to 2018 influenza season indicates that 84.1 percent of positive samples were influenza A, while 15.9 percent were influenza B. If a rapid antigen test is performed and then confirmed using PCR, the second test may require the -59 modifier. CPT Code. This culture is for the isolation of influenza A and influenza B, other viral agents will not routinely be detected. An asterisk (*) indicates a The physician makes the determination to run both influenza A and B tests and a rapid . External controls. The Medicare program provides limited benefits for outpatient prescription drugs. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only Additional information regarding LOINC codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf. The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, ICD-9 code for sports physicals. If a CLIA-waived test is performed, the -QW modifier should be reported for the waived test. testing to when the result is released to the ordering provider. our vaccine rep inform us to code 87804 and 87804(-91) because we are billing for both A and B. we just started to bill this, not sure of reimbursement yet. Please visit the. announces CPT code for antigen tests in the CPT code approved for SARS-CoV-2 antigen testing. All rights reserved. HOWEVER, WHAN ANOTHER ALREADY ESTABLISHED MODIFIER IS APPROPRIATE IT SHOULD BE USED RATHER THAN MODIFIER -59. Applicable FARS\DFARS Restrictions Apply to Government Use. 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. DISCLOSED HEREIN. Color-coded control swab packaging for easy positive/negative . FDA officials see it as another step toward diagnostic testing at home for certain viruses. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Influenza testing (using molecular methods) is recommended for hospitalized patients with suspected influenza. hbbd```b``z"gIi MD>*{`S`0 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. For use with Sofia 2 and Sofia. Accessed 4/27/21. The document is broken into multiple sections. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. Flu A: 87804; Flu B: 87804-59 (modifier used to indicate separate test) Detectable Analytes. In the United States, a number of RIDTs are commercially available. descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work Administration of influenza virus vaccine (allowable same as CPT 90471) 90653: Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use: 90662: Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use: 90672 As laboratory tests, Medicare will cover these codes at 100% of their allowed amount with no deductible or coinsurance applied. Van Voris LP. Centers for Disease Control and Prevention (CDC) recommendations: Use rapid diagnostic tests with high sensitivity and specificity. In some cases, additional time should be CHICAGO The American Medical Association (AMA) today published an update to the Current Procedural Terminology (CPT) code set that includes new code additions and editorial revisions for reporting medical services sparked by the public health response to the COVID-19 pandemic. and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only For a better experience, please enable JavaScript in your browser before proceeding. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Kits may test for influenza A, influenza B, or both and may provide a single result or separate results when testing for both A and B. copied without the express written consent of the AHA. There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. DISTINCT PROCEDURAL SERVICE: UNDER CERTAIN CIRCUMSTANCES, THE PHYSICIAN MAY NEED TO INDICATE THAT A PROCEDURE OR SERVICE WAS DISTINCT OR INDEPENDENT FROM OTHER SERVICES PERFORMED ON THE SAME DAY. Complete absence of all Revenue Codes indicates October 16, 2020. Best answers. The AMA is a third party beneficiary to this Agreement.