Understanding the Different Billing Codes for Covid-19 Surveillance Testing

During the Covid-19 pandemic, Surveillance Testing has become a crucial tool in tracking and controlling the spread of the virus. Healthcare Providers use various billing codes to bill for Covid-19 Surveillance Testing, depending on the type of test and the circumstances under which it was performed. In this article, we will discuss the different billing codes for Covid-19 Surveillance Testing.

What is Covid-19 Surveillance Testing?

Covid-19 Surveillance Testing is a type of testing that is done on populations to monitor the spread of the virus. It is different from diagnostic testing, which is done on individuals who have symptoms or have been exposed to the virus. Surveillance Testing helps public health officials track the prevalence of Covid-19 in the community and make informed decisions about public health interventions.

Types of Covid-19 Surveillance Testing

There are several types of Covid-19 Surveillance Testing, including:

1. PCR tests
2. Antigen tests
3. Antibody tests

Types of Billing Codes for Covid-19 Surveillance Testing

1. CPT Code 87635

CPT code 87635 is used to bill for Covid-19 infectious agent detection by nucleic acid (DNA or RNA) using amplified probe technique. This code is typically used for PCR tests, which are considered the gold standard for diagnosing Covid-19. PCR tests detect the genetic material of the virus in a sample taken from a patient's nose or throat.

2. CPT Code 87426

CPT code 87426 is used to bill for Covid-19 antigen testing. Antigen tests detect specific proteins on the surface of the virus in a sample taken from a patient's nose or throat. These tests are less sensitive than PCR tests but provide faster results, making them useful for Surveillance Testing in certain situations.

3. CPT Code 86328

CPT code 86328 is used to bill for Covid-19 antibody testing. Antibody tests detect the presence of antibodies that the body produces in response to an infection with the virus. These tests can help determine if a person has been infected with Covid-19 in the past, even if they did not have symptoms.

Modifiers for Covid-19 Testing

In addition to the billing codes listed above, Healthcare Providers may need to use modifiers to indicate specific circumstances under which the testing was performed. Some common modifiers for Covid-19 testing include:

1. Modifier QW: CMS.gov/medicare/quality/clinical-laboratory-improvement-amendments" target="_blank">CLIA-waived test
2. Modifier CR: Covid-19 specimen collection
3. Modifier CS: Covid-19 specimen processing

Documentation Requirements for Covid-19 Surveillance Testing

When billing for Covid-19 Surveillance Testing, Healthcare Providers must ensure that they meet certain documentation requirements to support the billing codes they use. Some key documentation requirements include:

1. Documentation of the patient's symptoms or exposure to Covid-19
2. Documentation of the type of test performed
3. Documentation of the test result
4. Documentation of any modifiers that were used

Insurance Coverage for Covid-19 Surveillance Testing

Most health insurance plans cover Covid-19 Surveillance Testing, including PCR, antigen, and antibody tests. The CARES Act requires health insurance plans to cover Covid-19 testing without cost-sharing for the patient, meaning that patients should not have to pay out-of-pocket for testing.

Conclusion

Covid-19 Surveillance Testing plays a critical role in monitoring the spread of the virus and informing public health interventions. Healthcare Providers use various billing codes to bill for Surveillance Testing, including CPT codes 87635, 87426, and 86328. By understanding the different billing codes and documentation requirements for Covid-19 Surveillance Testing, Healthcare Providers can ensure that they are properly reimbursed for the testing they perform.

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