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87806
Quick jump to procedure code: Printer Friendly Version
87808

CPT® 87807: INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; RESPIRATORY SYNCYTIAL VIRUS

Short Description: Rsv assay w/optic

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
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
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TEXAS-Brazoria
TEXAS-Dallas
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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
2016 Laboratory Fee Schedule: $16.33

Revenue Code(s):
306-Laboratory-bacteriology & microbiology



2016 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.
PercentageICD-9ICD-10 Conversions
23.5% 786.2    Cough R05   Cough
5.9% 780.64    Chills (without fever) R68.83   Chills (without fever)
5.9% 729.1    Myalgia and myositis, unspecified M60.9   Myositis, unspecified
OR:
M79.1   Myalgia
OR:
M79.7   Fibromyalgia
5.9% 493.90    Asthma, unspecified, unspecified J45.909   Unspecified asthma, uncomplicated
OR:
J45.998   Other asthma
5.9% 466.11    Acute bronchiolitis due to respiratory syncytial virus (RSV) J21.0   Acute bronchiolitis due to respiratory syncytial virus
5.9% 466.0    Acute bronchitis J20.9   Acute bronchitis, unspecified
5.9% 465.9    Upper respiratory infection, unspecified sites J06.9   Acute upper respiratory infection, unspecified
5.9% 464.00    Acute laryngitis without mention of obstruction J04.0   Acute laryngitis
5.9% 462    Acute pharyngitis J02.9   Acute pharyngitis, unspecified
5.9% 428.0    Congestive heart failure I50.9   Heart failure, unspecified

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

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.

CCI Edits for 87807
Denied Codes (1)
Effective
Modifier
Accepted (2)
87147 Culture type immunologic
04/01/2006 Yes
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
 
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.


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 162
MERVIN WOLFF -DETROIT,MI 125
JEFFREY KRAMER -WALTERBORO,SC 34
JONATHAN MARTINEZ -MONTCLAIR,CA 22
NELSON MATA -SAN JUAN,TX 15

   87807 Top 5 Ordering Organizations National*
BIO-REFERENCE LABORATORIES, INC.-NJ 136
QUEST DIAGNOSTICS NICHOLS INSTITUTE, INC.-VA 55
LABORATORY CORPORATION OF AMERICA HOLDINGS-NJ 20
MERITER HEALTH ENTERPRISES INC.-WI 18
FLORIDA CLINICAL LABORATORY INC-FL 18

*Based on 2014 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 2014: 1,162
Total Services Denied 2014: 248 (21.3%)
National Charges Submitted 2014: $ 61,267.00
National Charges Allowed 2014: $ 14,347.00
National Average (No Modifier) Fee Submitted 2014: $ 61.70
National Average (No Modifier) Fee Allowed 2014: $ 15.55
National Average (QW) Fee Submitted 2014: $ 41.22
National Average (QW) Fee Allowed 2014: $ 15.87


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Internal medicine 449 38.6% $ 34.10 79 17.6%
Clinical laboratory
(billing independently)
380 32.7% $ 85.70 93 24.5%
Family practice 189 16.3% $ 39.16 47 24.9%
Physician assistant
(eff 5/92)
46 4.0% $ 41.07 4 8.7%
Nurse practitioner 44 3.8% $ 39.41 8 18.2%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 725 62.4% $ 36.27 127 17.5%
Independent laboratory 380 32.7% $ 85.70 93 24.5%
Urgent Care Facility (eff. 1/1/03) 52 4.5% $ 41.41 25 48.1%
Home 2 0.2% $ 30.00 2 100.0%
Rural health clinic 2 0.2% $ 35.00 1 50.0%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 669 57.6% $ 61.72 186 27.8%
QW - CLIA Waived Category Test 438 37.7% $ 41.23 38 8.7%
59 - Distinct Procedural Service 37 3.2% $ 27.87 22 59.5%
90 - Reference (Outside) Laboratory 17 1.5% $ 50.23 2 11.8%
CC 1 0.1% $ 50.00 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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05/30/2016 09:22:39 54.80.212.195

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