COVID-19 Medical Billing Updates

The American Medical Association (AMA) is responsible for releasing the Current Procedural Terminology (CPT) used by physicians, accreditation organizations, and insurance companies to communicate diagnostic, medical, and surgical procedures. AMA especially recommends using CPT to process claims, informing insurance payers what methods they need to pay to the healthcare provider.

On June 25, 2020, AMA updated the COVID-19 General Billig Guide and the COVID-19 Community-Based Testing Billing Guide to include new CPT codes for active billing with insurance systems. The new codes released by AMA are CPT 87426 and CPT 86413.

Lab Code CPT 86413

CPT 86413 took effect on September 8, 2020. This CPT code was released when laboratory tests provided quantitative measurements of severe acute respiratory syndrome coronavirus, also known as SARS-CoV, SARS-CoV-2, or COVID-19, antibodies, instead of a simple positive/negative result reported by previous CPT codes. CPT 86413 proves to be more helpful because the procedure monitors a person’s adaptive immune response to COVID-19 and the effectiveness of treatments against it. 

Lab Code CPT 87426

Lab code 87426 is the code for infectious agent antigen detection by immunoassay technique, that can be the semiquantitative or qualitative, multiple-step method used to diagnose COVID-19. It was effective by June 25, 2020.

The immunoassay technique is a bioanalytical procedure that is sensitive enough to detect the concentration or the presence of a chemical substance. This procedure is sensitive and thorough enough to trace small to macro-sized molecules in a solution using an antigen to identify the foreign chemical substance. In the case of COVID-19, the immunoassay technique uses saliva as the specimen.

CPT 87426 falls as an add-on code to the older CPT 87301, an infectious agent antigen detection by immunoassay technique previously used to diagnose HIV infections, pregnancy tests, measure cytokines, and more. AMA added CPT 87426 to help clarify and further specify the procedures used for more accessible and more efficient tracking and billing.

It is important to note that claimants can submit requests for these codes back to the dates these codes came into effect. To emphasize, for CPT 86413, claimants can submit back to September 8, 2020. For CPT 87426, claimants can submit it back to June 25, 2020.

CPT Codes and Immunization

The purpose of CPT codes in this context is to report the immunizations for the novel coronavirus. Each COVID-19 vaccine is assigned a specific CPT code for easier tracking. Each vaccine also comes with a unique administration code to track the when and where of vaccine distribution.

The vaccine CPT codes allow data-driven analysis and reports that can help plan where to allocate vaccines and improve vaccine performance.

AMA continuously releases and updates this code list as more information about COVID-19 is learned and more laboratory tests and diagnosing procedures are developed. The existing CPT Editorial Panel continues to monitor the available information about the COVID-19 as it progresses, tracking the new clinical indications for antigen tests. As new antigen codes are created, the codes are immediately put into effect to track COVID-19 testing consistently.