GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION, PRODUCT, OR PROCESSES The AMA does not directly or indirectly practice medicine or dispense medical services. If your session expires, you will lose all items in your basket and any active searches. 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 . 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. You can collapse such groups by clicking on the group header to make navigation easier. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. apply equally to all claims. required field. "JavaScript" disabled. If a rapid antigen test is performed and then confirmed using PCR, the second test may require the -59 modifier. If reflex testing is performed, concomitant CPT codes/charges will apply. J Clin Microbiol. . Throat or nasopharyngeal (NP) swab or wash, sputum, bronchial washings, bronchoalveolar lavage (BAL). . If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. Room Temperature. Applicable FARS/HHSARS apply. Residents and fellows deciding on a practice setting should be armed with all the relevant details. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Anterior nasal swabs (self-collected under healthcare provider (HCP) supervision or HCP-collected) are also considered . MODIFIER CODE 09959 MAY BE USED AS AN ALTERNATE TO MODIFIER -59. Shaw MW, Arden NH, Maassab HF. Instructions for enabling "JavaScript" can be found here. Revision Explanation: Under CPT/HCPCS Codes Group 1: Codes the description was revised for 87400. 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. 2021 Laboratory Corporation of America Holdings and Lexi-Comp Inc. All Rights Reserved. (Press Enter or Space to Go to Landing Page or Press Down to expand Menu), Reflex Table for Viral Culture,Rapid,Influenza, Federally Qualified Health Centers (FQHCs), Virus, Direct Detection DFA, Respiratory Syncytial Virus (RSV), Combatting Modern Slavery and Human Trafficking Statement. This Agreement will terminate upon notice if you violate its terms. The CMS.gov Web site currently does not fully support browsers with Of these, only two showed a positive RAD test for Influenza A. Qty Check Availability. If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. Description. of every MCD page. You must log in or register to reply here. The Medicare National Limit amount* is $16.36. Consider sending respiratory specimens (from symptomatic patients) for RT-PCR to confirm results of RIDTs, especially in the following situations: When community influenza activity is low and the rapid diagnostic test result is positive. 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. This email will be sent from you to the Collect respiratory tract specimens as early in the illness as possible (within 3-4 days of illness onset). 2016;54(11):2763-2766. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. Centers for Disease Control and Prevention (CDC) recommendations: Use rapid diagnostic tests with high sensitivity and specificity. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. authorized with an express license from the American Hospital Association. We called Medicare and they said. In: Belshe RB, ed. The CPT Editorial Panel also revised CPT codes ranging from 87301 to 87430 by removing . Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. 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. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). . COVID-19/Flu A&B Diagnostic Test. used to report this service. Draft articles have document IDs that begin with "DA" (e.g., DA12345). CPT codes, descriptions and other data only are copyright 2022 American Medical Association. The American Medical Association is the physicians powerful ally in patient care. CMS and its products and services are not endorsed by the AHA or any of its affiliates. 23-043-070. Information for Clinicians on Rapid Diagnostic Testing for Influenza. f Zhq,3&,w+0bv ]LL Learn more with the AMA. "JavaScript" disabled. You can use the Contents side panel to help navigate the various sections. Download AMA Connect app for You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. You can collapse such groups by clicking on the group header to make navigation easier. 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. Molnlycke Exufiber absorption comparison. COVID, Flu A/B, and RSV Panel | Diagnostic Laboratory of Oklahoma Influenza: Coding for Related Tests and Services Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. That's why we've developed Alinity TM m Resp-4-Plex, a new assay running on our advanced Alinity m system that tests for COVID-19, flu A, flu B, and RSV using only one swab. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Accessed 4/27/21. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. The AMA does not directly or indirectly practice medicine or dispense medical services. opportunity for Oseltamivir (Tamiflu) treatment for positive patients, Results available in approximately 2-4 hours, Article - Billing and Coding: Influenza Diagnostic Tests (A58817). The document is broken into multiple sections. All rights reserved. An official website of the United States government. The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, If a rapid antigen test is performed and then confirmed using PCR, the second test may require the -59 modifier. Influenza testing (using molecular methods) is recommended for hospitalized patients with suspected influenza. In addition to SARS-CoV-2 and RSV, the Labcorp Seasonal Respiratory Virus RT-PCR DTC Test can detect influenza . End User Point and Click Amendment: Rapid Influenza Diagnostic Tests (RIDTs) | CDC PCR confirmed positive and negative clinical samples were screened with the Panbio COVID-19/Flu A&B Rapid Panel test, an lateral flow strip immunoassay for nucleocapsid proteins of CoV-1, Influenza A and B. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. It is typified by the Quidel's QuickVue Influenza test. Influenza testing (using molecular methods) is recommended for hospitalized patients with suspected influenza. Please do not use this feature to contact CMS. 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. Rapid Influenza Diagnostic Tests | CDC Two of the newly approved codes report nucleic acid assays that allow a single test to simultaneously detect the novel coronavirus and a combination of common viral infectious agents, including influenza A/B and respiratory syncytial virus, said AMA President Susan R. Bailey, M.D. XLSX kjc.cpu.edu.cn MACs are Medicare contractors that develop LCDs and Articles along with processing of Medicare claims. COVID-19/Flu A&B test is intended to aid in the rapid differential diagnosis of Influenza A, B, and SARS-CoV-2 viral infection. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. In: Balows A, Hausler WJ, et al, eds. The AMA does not directly or indirectly practice medicine or dispense medical services. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. An official website of the United States government. Revenue Codes are equally subject to this coverage determination. Viral transport medium acceptable for collection of influenza specimens in 1 mL or 3 mL volumes can be used to transport swabs for COVID-19 testing. PDF Commonly Ordered COVID-19, Influenza, and RSV Clinical Diagnostic The Medicare program provides limited benefits for outpatient prescription drugs. HOWEVER, WHAN ANOTHER ALREADY ESTABLISHED MODIFIER IS APPROPRIATE IT SHOULD BE USED RATHER THAN MODIFIER -59. Article - Billing and Coding: Influenza Diagnostic Tests (A59055) By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. Positive and negative included. AMA announces CPT code for antigen tests in the fight against COVID-19 RIDTs can provide results within approximately 15 minutes. Rapid qualitative test that detects Influenza type A and type B antigens directly from nasal swab, nasopharyngeal swab, and Nasopharyngeal aspirate / wash specimens. CDT is a trademark of the ADA. authorized with an express license from the American Hospital Association. The Solution. Includes: influenza A (non-novel), influenza B, influenza C. Vignette. 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 Available FDA cleared tests as of August 2020. Status COVID-19/Flu A&B: - USA Manufactured and Delivered. LOINC Code 95942-9 Influenza virus A and B and SARS-CoV+SARS-CoV-2 (COVID-19) Ag panel - Upper respiratory specimen by Rapid immunoassay. The codes are for multi-virus tests that can detect both COVID-19 and other viruses, like the flu. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. that coverage is not influenced by Bill Type and the article should be assumed to Positive and negative included. FDA officials see it as another step toward diagnostic testing at home for certain viruses. If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. Some articles contain a large number of codes. The product we use is "Quick Vue Influenza". Catalog No. There is a risk of false negative for flu A, B, RSV, and SARS-CoV-2 results under certain co-infection circumstances with Pneumocystis jirovecii (PJP). Test code: 97636. The AMA is your steadfast ally from classroom to Match to residency and beyond. Reporting negatives and combined reporting in 30 minutes. All Rights Reserved (or such other date of publication of CPT). The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. CMS and its products and services are End User License Agreement: All rights reserved. Explore reports on this topic from the Council on Medical Education presented during the AMA Interim and Annual Meetings. End Users do not act for or on behalf of the CMS. The AMA promotes the art and science of medicine and the betterment of public health. 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. For a better experience, please enable JavaScript in your browser before proceeding. Instructions for enabling "JavaScript" can be found here. For use under the Emergency Use Authorization (EUA) only For in vitro If a rapid antigen test is performed and then confirmed using PCR, the second test may require the -59 modifier. Answers to questions on CPT coding and content are available from the CPT Network. 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. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Rapid and accurate detection of influenza A, influenza B, and respiratory syncytial virus in a single test for nasopharyngeal swab specimens . Influenza A, B & RSV PCR Panel - University of Washington The test is intended for use in the simultaneous rapid in vitro detection and differentiation of SARS-CoV-2, influenza A virus, and influenza B virus nucleocapsid protein antigen , but does not . preparation of this material, or the analysis of information provided in the material. CONTENTS: 25 Test Cassettes, 25 Sterile Swabs, 25 Extraction Reagent Capsules, 1 Positive Control Swab, 1 Negative Control Swab, 1 Procedure Card, 1 Instructions for Use. Next video. You need modifer -QW for Medicare patients. When we billed Medicare for both of these CPTs they were denied . The revision clarifies the proper reporting for antigen tests that are read by a machine, as compared to those which can be visually interpreted without a machine. used to report this service. Test code: 11177. Influenza A and B Antigen Immunoassay | Diagnostic Laboratory of Oklahoma The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Coding Common Respiratory Problems in ICD-10 | AAFP Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. This email will be sent from you to the Concurrent detection promises to conserve important testing resources, allowing for ongoing surveillance of influenza while testing for the novel coronavirus.. Performance of Rapid Sofia Influenza A+B Test Compared to Luminex X-Tag You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. 87804-QW, infectious agent antigen detection by immunoassay with direct optical observation; influenza. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. iPhone or The following summary provides a list of the main available types of diagnostics tests: Contact your local or state health department for information about influenza activity. Reference: Centers for Disease Control and Prevention. Bacterial swab specimen; specimen received in grossly leaking transport container; dry specimen; specimen submitted in fixative or additive; specimen received in expired transport medium or incorrect transport device; inappropriate specimen transport conditions; specimen received after prolonged delay in transport (usually more than 72 hours); wooden shaft swab in transport device; unlabeled specimen or name discrepancy between specimen and test request label, Isolate and identify influenza virus as an etiologic agent in cases of influenza and viral pneumonia, Shell vials or equivalent multiwell plate culture with fluorescent antibody staining. will not infringe on privately owned rights. ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, Information for Clinicians on Rapid Diagnostic Testing for Influenza, VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE IDENTIFICATION BY CYTOPATHIC EFFECT, VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE IDENTIFICATION (EG, HEMABSORPTION, NEUTRALIZATION, IMMUNOFLUORESCENCE STAIN), EACH ISOLATE, VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL) TECHNIQUE, INCLUDES IDENTIFICATION WITH IMMUNOFLUORESCENCE STAIN, EACH VIRUS, INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B VIRUS, INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA A VIRUS, 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; INFLUENZA, A OR B, EACH, INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, INCLUDES REVERSE TRANSCRIPTION, WHEN PERFORMED, AND AMPLIFIED PROBE TECHNIQUE, EACH TYPE OR SUBTYPE, INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MULTIPLE TYPES OR SUB-TYPES, INCLUDES MULTIPLEX REVERSE TRANSCRIPTION, WHEN PERFORMED, AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE, FIRST 2 TYPES OR SUB-TYPES, INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MULTIPLE TYPES OR SUB-TYPES, INCLUDES MULTIPLEX REVERSE TRANSCRIPTION, WHEN PERFORMED, AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE, EACH ADDITIONAL INFLUENZA VIRUS TYPE OR SUB-TYPE BEYOND 2 (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL (IE, VISUAL) OBSERVATION; INFLUENZA. 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. (the prototype used was POCT rapid Strep screening). CMS believes that the Internet is New CPT codes for multi-virus tests detect COVID-19 and flu Unless specified in the article, services reported under other The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. Quidel Sofia Influenza A+B FIA Kit - Fisher Sci Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Neither the United States Government nor its employees represent that use of such information, product, or processes In no event shall CMS be liable for direct, indirect, special, incidental, or consequential COVID/FLU/RSV Respiratory Panel, Rapid PCR - University of Washington not endorsed by the AHA or any of its affiliates. Follow manufacturers instructions, including handling of respiratory specimens, as described in the device package insert. Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. an effective method to share Articles that Medicare contractors develop. Thanks. Flu A: 87804; Flu B: 87804-59 (modifier used to indicate separate test) Detectable Analytes. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. SPECIAL BULLETIN COVID-19 #155: Laboratory Codes for COVID-19 - NCDHHS The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). In most instances Revenue Codes are purely advisory. Complete absence of all Bill Types indicates OneStep Influenza - Henry Schein Medical The CPT Editorial Panel also revised CPT codes ranging from 87301 to 87430 by removing the undefined term multi step method from code descriptors. Waner JL, Todd, SI, Shalaby H, et al. Coding & Documentation | Aafp End User License Agreement: New ICD-10-CM guidance addresses coding for MIS-C, COVID, influenza hb```G@(p+PjHQTWO:-:Tp20Wi! an effective method to share Articles that Medicare contractors develop. Cepheid | Flu A and Flu B Molecular Test - Xpert Xpress Flu If a CLIA-waived test is performed, the -QW modifier should be reported for the waived test. 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 . A patient presents with flu-like symptoms. AHA copyrighted materials including the UB‐04 codes and Influenza A/B PCR, RAPID | OHSU All Rights Reserved (or such other date of publication of CPT). Tests will be run in the order of receipt only, tests remaining at the end of each shift will be reordered under NCVQLT for transport to UW Virology. Source: Regenstrief LOINC Part Description . FLUNP - Overview: Influenza Virus Type A and Type B, and Respiratory Status Covid-19/Flu A&B $537.62/Box of 25 DocRx 33225 - MDSupplies There are multiple ways to create a PDF of a document that you are currently viewing. Add to cart. Evaluation of the Diagnostic Performance of a SARS-CoV-2 and Influenza For swabs in saline: OP, NP or anterior nasal swabs may be placed in 1 to 3 mL of sterile saline (0.85 to 0.9%) in a sterile screw cap container. 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. For more information, please view the literature below. ICD-9 code for sports physicals. Table 2: Available FDA-Cleared Rapid Influenza Diagnostic Tests (Antigen Detection Only) 1. Includes: Influenza A & B. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom