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87806
Quick jump to procedure code: Printer Friendly Version
87808

87807: Rsv assay w/optic CPT® 87807: INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; RESPIRATORY SYNCYTIAL VIRUS

Short Description: Rsv assay w/optic

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CPT copyright 2016 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State
2017 Laboratory Fee Schedule: $16.44


2017 OPPS Status Indicator: Q4

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Limited claims data available for this procedure.
Percentage
ICD-10 Code
Description
Related DRG(s)
20.0%
J32.9
Chronic sinusitis, unspecified
152-153
20.0%
J02.9
Acute pharyngitis, unspecified
011-013
152-153
20.0%
J12.9
Viral pneumonia, unspecified
193-195
974-976
10.0%
J18.9
Pneumonia, unspecified organism
193-195
793
974-976
10.0%
D84.9
Immunodeficiency, unspecified
814-816
10.0%
H66.92
Otitis media, unspecified, left ear
152-153
10.0%
I02.0
Rheumatic chorea with heart involvement
314-316

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

87807 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Column 1 CCI Edits for 87807
Denied Codes (1) Effective Modifier
Accepted (2)
80500 Lab pathology consultation 07/01/2005 Yes
80502 Lab pathology consultation 07/01/2005 Yes
87280 Respiratory syncytial ag if 04/01/2006 Yes
87420 Resp syncytial ag ia 04/01/2006 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 87807.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 87807
Denied Codes (1)
Effective
Modifier
Accepted (2)
87147 Culture type immunologic
04/01/2006 Yes
87631 Resp virus 3-5 targets
01/01/2017 Yes
87632 Resp virus 6-11 targets
01/01/2017 Yes
87633 Resp virus 12-25 targets
01/01/2017 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
87797 Detect agent nos dna dir
04/01/2006 Yes
87798 Detect agent nos dna amp
04/01/2006 Yes
87799 Detect agent nos dna quant
04/01/2006 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 87807.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 87807


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 2 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Clinical: Data Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   87807 Top 5 Ordering Providers National*
NAUMAN QURESHI -LAKE CHARLES,LA 189
MERVIN WOLFF -DETROIT,MI 134
JEFFREY KRAMER -WALTERBORO,SC 49
CLAYTON ROYDER -OKLAHOMA CITY,OK 32
FRANK EVANOV -NEW HYDE PARK,NY 32

   87807 Top 5 Ordering Organizations National*
BIO-REFERENCE LABORATORIES, INC.-NJ 659
MERITER HEALTH ENTERPRISES INC.-WI 36
BIO-REFERENCE LABORATORIES INC-CA 22
FLORIDA CLINICAL LABORATORY, INC-FL 18

*Based on 2015 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 87807*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 1,980
Total Services Denied 2015: 430 (21.7%)
National Charges Submitted 2015: $ 88,523.65
National Charges Allowed 2015: $ 24,014.28
National Average (No Modifier) Fee Submitted 2015: $ 47.52
National Average (No Modifier) Fee Allowed 2015: $ 15.33
National Average (QW) Fee Submitted 2015: $ 38.76
National Average (QW) Fee Allowed 2015: $ 15.86


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
983 49.6% $ 55.72 189 19.2%
Internal medicine 617 31.2% $ 32.09 152 24.6%
Family practice 204 10.3% $ 34.60 40 19.6%
Nurse practitioner 87 4.4% $ 37.57 35 40.2%
Physician assistant
(eff 5/92)
31 1.6% $ 39.52 4 12.9%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 981 49.5% $ 55.63 189 19.3%
Office 951 48.0% $ 33.53 226 23.8%
Urgent Care Facility (eff. 1/1/03) 44 2.2% $ 40.18 14 31.8%
Federally qualified health centers (eff. 10/1/93) 3 0.2% $ 47.33 1 33.3%
Nursing facility 1 0.1% $154.80 0 0.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 1,269 64.1% $ 47.52 320 25.2%
QW - CLIA Waived Category Test 563 28.4% $ 38.76 47 8.3%
59 - Distinct Procedural Service 74 3.7% $ 25.21 44 59.5%
90 - Reference (Outside) Laboratory 62 3.1% $ 59.70 19 30.6%
GW 12 0.6% $ 69.40 0 0.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


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All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

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08/19/2017 10:03:30 54.156.92.46

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