Commonly Ordered COVID-19, Influenza, and RSV Clinical Diagnostic Laboratory Tests (Updated May 5, 2021)

Summary

Table titled Commonly Ordered COVID-19, Influenza, and RSV Clinical Diagnostic Laboratory Tests for which Medicare Allows One Test Without a Practitioner Order During the PHE, updated May 5, 2021. It lists CPT/HCPCS codes with long descriptors and target, beginning with COVID-19 Related Codes. The entries include U0001, a CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel, and U0002 through U0005, which describe SARS-CoV-2 tests including high throughput technologies. They also include antibody codes such as 86328, 86408, 86409, 86413 and 86769, antigen detection codes 87426 and 87811, nucleic acid code 87635 and code 0224U.

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“Commonly Ordered COVID-19, Influenza, and RSV Clinical Diagnostic Laboratory Tests (Updated May 5, 2021).” Original at www.cms.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/ppr-int-b1b220c9b30019c9-list-of-lab-test-codes-for-covid-19-influenza-a10b5ed8fb/, SHA-256 1496691bd575e84515ef3c39d6c18e50771d60ef9d6d1ea9bd86c477d6383e33.

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             Commonly Ordered COVID-19, Influenza, and RSV Clinical Diagnostic
               Laboratory Tests for which Medicare Allows One Test Without a
                             Practitioner Order During the PHE*
                                                         Updated May 5, 2021

CPT/ HCPCS                                    Laboratory Code Long Descriptor                                            Target
  Code
                                                  1. COVID-19 Related Codes
U0001        CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel                                                            COVID-19
U0002        2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or                   COVID-19
             subtypes (includes all targets), non-CDC)
U0003        Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2  COVID-19
             (SARS-CoV-2) (Coronavirus disease [COVID-19]), 2 amplified probe technique, making use of high throughput
             technologies as described by CMS-2020-01-R
U0004        2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or                  COVID-19
             subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-
             2020-01-R
U0005                                                                                                                  COVID-19
             Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2
             (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, CDC or non-CDC, making use of
             high throughput technologies, completed within two calendar days from date and time of specimen
             collection. (List separately in addition to either HCPCS code U0003 or U0004)
86328                                                                                                                   COVID-19
             Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg,
             reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus
             disease [COVID-19])
86408        Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease   COVID-19
             [COVID-19]); screen
86409        Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease   COVID-19
             [COVID-19]); titer
86413        Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody,    COVID-19
             quantitative
86769        Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])    COVID-19


                                                                                                                    05/05/2021
87426   Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-              COVID-19
        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])
87635   Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2         COVID-19
        (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
87811   Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute     COVID-19
        respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
0224U   Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),         COVID-19
        includes titer(s), when performed
0226U   Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)         COVID-19
        (Coronavirus disease [COVID-19]), ELISA, plasma, serum
G2023   Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease        COVID-19
        [COVID-19]), any specimen
G2024   Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease        COVID-19
        [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source
                                                2. Influenza and/or RSV Codes
87275   Infectious agent antigen detection by immunofluorescent technique; influenza B virus                             Influenza
87276   Infectious agent antigen detection by immunofluorescent technique; influenza A virus                             Influenza
87279   Infectious agent antigen detection by immunofluorescent technique; Parainfluenza virus, each type                Influenza
87280   Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus                   Influenza/RSV
87400   Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-              Influenza
        linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or
        semiquantitative, multiple-step method; Influenza, A or B, each
87420   Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-            Influenza/RSV
        linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or
        semiquantitative, multiple-step method; respiratory syncytial virus
87501   Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, includes reverse transcription, when Influenza
        performed, and amplified probe technique, each type or subtype
87502   Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub- types,    Influenza
        includes multiplex reverse transcription, when performed, and multiplex amplified probe
        technique, first 2 types or sub-types
87503   Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub- types,      Influenza
        includes multiplex reverse transcription, when performed, and multiplex amplified probe technique,

                                                                                                                      05/05/2021
              each additional influenza virus type or sub-type beyond 2 (List separately in addition to code for primary
              procedure)
87631                                                                                                                          Influenza/RSV
              Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus,
              coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes
              multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types
              or subtypes, 3-5 targets
87634         Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus, amplified probe            Influenza/RSV
              technique
87804         Infectious agent antigen detection by immunoassay with direct optical observation; Influenza                     Influenza
87807         Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial         Influenza/RSV
              virus
                                                          3. Combination Codes
87428         Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA],                      Influenza and
              enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA],                                       COVID-19
              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
87636         Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2         Influenza and
              (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe       COVID-19
              technique
87637         Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2         Influenza/RSV
              (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus,   and COVID-19
              multiplex amplified probe technique
0240U         Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute           Influenza and
              respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen,          COVID-19
              each pathogen reported as detected or not detected
0241U         Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute           Influenza/RSV
              respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]),   and COVID-19
              upper respiratory specimen, each pathogen reported as detected or not detected

* When furnished simultaneously, one test from each of the first two categories (1. COVID-19; 2. Influenza/RSV Related) is allowed without a
practitioner order during the public health emergency for COVID-19. Alternatively, one test from the third category (3. Combination Codes) is
allowed without a practitioner order during the public health emergency for COVID-19. G2023 or G2024 are allowed without a practitioner
order during the public health emergency for COVID-19, when billed appropriately. Other Medicare conditions of coverage and payment
continue to apply, including any applicable local coverage determinations. This list does not necessarily represent all COVID-19 and related
codes that may be covered by the Medicare program.

                                                                                                                           05/05/2021

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