Public Health

New CPT code for COVID-19 testing: What you should know

What’s the news: The AMA Current Procedural Terminology (CPT®) Editorial Panel last week adopted a new CPT code that describes laboratory testing for the novel coronavirus—SARS-CoV-2—that causes COVID-19. The CPT code is now effective and can be used. Physicians and others can learn more about the CPT code and the short, medium and long descriptors for it.

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Why it matters for patients and physicians: The move comes just days after the World Health Organization (WHO) declared the spread of COVID-19 to be a global pandemic and offers a vital tool to help support the response to the urgent public health need for streamlined reporting of novel coronavirus testing offered by hospitals, health systems and laboratories in the United States.

“Moving as quickly as possible to put in place a CPT code for a novel coronavirus test will bolster a data-driven response to the COVID-19 disease outbreak in the United States,” said AMA President Patrice A. Harris, MD, MA. “By streamlining the flow of information on novel coronavirus testing, a new CPT code facilitates the reporting, measuring, analyzing, researching and benchmarking that is necessary to help guide the nation’s response to the public health emergency.”

The CPT Editorial Panel is an independent body convened by the AMA with sole authority to manage revisions to the CPT code set. Throughout the past several weeks, the AMA has worked closely with leaders at the Centers for Disease Control and Prevention (CDC) and experts in the health care community to ensure the new CPT code meets the emergent demands for accurate reporting of a diagnostic test to detect the novel coronavirus.

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A Physician's Guide to COVID-19

The AMA will continue to keep physicians informed of the CDC’s resources and updates, including on the AMA’s COVID-19 online resource center and through its physician’s guide to COVID-19. Additionally, the JAMA Network™ has a comprehensive overview of the coronavirus—including epidemiology, infection control and prevention recommendations—available on its JN Learning website.

What’s next: Here are a few key points that physicians, their teams and health care organizations should understand about using the new CPT code, 87635.

The full CPT code description is: “Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavrius 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.”

The Centers for Medicare & Medicaid Services has established two Healthcare Common Procedure Coding System codes for coronavirus testing. HCPCS code U0001 is for CDC labs to use, and HCPCS code U0002 is for non-CDC labs to use when reporting SARS-CoV-2 testing.

Physicians and health care organizations should check with local payers to determine their specific reporting guidelines for this new CPT code.

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Attentive physicians and coders will note that the pathology and laboratory section of the CPT code set already contains codes for coronavirus testing. But those are for nucleic acid assays that detect multiple respiratory viruses in a multiplex reaction, while CPT code 87635 is for the detection of SARS-CoV-2 (COVID-19) and any pan-coronavirus types or subtypes.

Recently published CDC guidelines on specimen collection for initial diagnostic testing recommend obtaining swabs from multiple pharyngeal sites, which may require conducting more than one test on the same day for a patient. The CPT guidelines for this new code provide the necessary flexibility to report this scenario, and accurately reflect the services performed.

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