2025 Coding Reference

Fee schedules do not reflect 2% Payment Adjustment (Sequestration).
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Infectious Disease
COVID-19
CLIA Waived
Oncology/Genetics
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DEX Z-Code® Sharing Instructions for Cepheid Tests



COVID-19

Test Name
CPT® Code
 Description
LOINC Code
Medicare Coverage
National
Medicare Reimbursement
National
Medicaid Reimbursement
Xpert® Omni-SARS-CoV-2

For emergency use under an Emergency Use Authorization (EUA)
87635
 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
94500-6
  CCI   MUE  
$ 51.31
N/A
The HCPCS codes for High Throughput Assays (U0003 and U0005) were discontinued EFFECTIVE FOR DATES OF SERVICE ON OR AFTER May 12, 2023 along with the PHE termination.

For more information, please see Laboratories: CMS Flexibilities to Fight COVID-19
Xpert® Xpress SARS-CoV-2
AND
Xpert® Xpress CoV-2 plus

For emergency use under an Emergency Use Authorization (EUA)
87635-QW1
 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
94500-6
  CCI   MUE  
$ 51.31
N/A
Xpert® Xpress CoV-2 plus

510K - IVD.
In Vitro Diagnostic Medical Device
87635
 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
94500-6
  CCI   MUE  
$ 51.31
N/A
Xpert® Xpress CoV-2/Flu/RSV
AND
Xpert® Xpress CoV-2/Flu/RSV plus

For emergency use under an Emergency Use Authorization (EUA)
0241U-QW1
(all targets ordered)
 Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected
95941-1
Results
94500-6 SARS-CoV-2 (COVID-19) RNA [Presence] in Respiratory specimen by NAA with probe detection
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92142-9Influenza virus A RNA [Presence] in Respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92141-1Influenza virus B RNA [Presence] in Respiratory specimen by NAA with probe detection
92131-2Respiratory syncytial virus RNA [Presence] in Respiratory specimen by NAA with probe detection
  CCI   MUE  
$142.63
N/A
0240U-QW1
(If only SARS CoV-2 / Flu is ordered)
 Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected
95422-2
Results
94500-6 SARS-CoV-2 (COVID-19) RNA [Presence] in Respiratory specimen by NAA with probe detection
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92142-9Influenza virus A RNA [Presence] in Respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92141-1Influenza virus B RNA [Presence] in Respiratory specimen by NAA with probe detection
  CCI   MUE  
$142.63
N/A
87635-QW1
(If only SARS CoV-2 is ordered)
 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
94500-6
  CCI   MUE  
$ 51.31
N/A
Xpert® Xpress CoV-2/Flu/RSV plus

510K - IVD.
In Vitro Diagnostic Medical Device
0241U
(all targets ordered)
 Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected
95941-1
Results
94500-6 SARS-CoV-2 (COVID-19) RNA [Presence] in Respiratory specimen by NAA with probe detection
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92142-9Influenza virus A RNA [Presence] in Respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92141-1Influenza virus B RNA [Presence] in Respiratory specimen by NAA with probe detection
92131-2Respiratory syncytial virus RNA [Presence] in Respiratory specimen by NAA with probe detection
  CCI   MUE  
$142.63
N/A
0240U
(If only SARS CoV-2 / Flu is ordered)
 Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected
95422-2
Results
94500-6 SARS-CoV-2 (COVID-19) RNA [Presence] in Respiratory specimen by NAA with probe detection
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92142-9Influenza virus A RNA [Presence] in Respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92141-1Influenza virus B RNA [Presence] in Respiratory specimen by NAA with probe detection
  CCI   MUE  
$142.63
N/A
87635
(If only SARS CoV-2 is ordered)
 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
94500-6
  CCI   MUE  
$ 51.31
N/A
87631
(If only Flu A/B + RSV is ordered)
 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
85476-0
Results
76089-2 Respiratory syncytial virus RNA [Presence] in Nasopharynx by NAA with probe detection
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
  CCI   MUE  
$142.63
N/A
87502
(If only Flu A/B is ordered)
 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
92882-0
Results
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
  CCI   MUE  
$ 95.80
N/A
The HCPCS codes for High Throughput Assays (U0003 and U0005) were discontinued EFFECTIVE FOR DATES OF SERVICE ON OR AFTER May 12, 2023 along with the PHE termination.

For more information, please see Laboratories: CMS Flexibilities to Fight COVID-19

(1) The QW modifier must be used when performing the assay under a CLIA waived license. Applicable to EUA product only.

Healthcare policy, economics and reimbursement information provided by Cepheid is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Cepheid encourages providers to submit accurate and appropriate claims for services. It is the provider's responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services rendered. Cepheid recommends that providers consult with payers, reimbursement specialists and/or legal counsel regarding coding, coverage and payment matters.

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04/28/2025 04:52:52 3.12.198.162