CodeMap®-Quidel Coding Reference

2023 Coding Reference

For questions, please email reimbursementsupport@quidelortho.com

Fee schedules do not reflect 2% Payment Adjustment (Sequestration).
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Rapid Diagnostics	Molecular Diagnostics	Cell Culture & Fluorescent Tests	ELISA
VITROS ECi/ECiQ	VITROS 350/XT 3400	VITROS 3600	VITROS 4600
	VITROS 5600	VITROS 7600
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Molecular Diagnostics Download this page as PDF

Adenovirus

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Lyra® Adenovirus

Nasal Swab

87798

76070-2

Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism

CCI MUE

$ 35.09

Bordetella

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Solana® Bordetella Complete	Nasopharyngeal Swab	87798	90441-7	Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism	CCI MUE	$ 35.09
		87798-59		Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism	CCI MUE	$ 35.09
				If all tests are ordered, performed, and reported:		$ 70.18

Coronavirus

FAQs about the FFCRA and CARES Acts

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Lyra SARS CoV-2	87635	94559-2	severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique	CCI MUE	$ 51.31
Lyra Direct SARS CoV-2	87635	94559-2	severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique	CCI MUE	$ 51.31
Solana® SARS-CoV-2 Assay	87635	94559-2	severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique	CCI MUE	$ 51.31

Gastrointestinal

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Lyra Direct C. difficile	Unformed stool	87493	80685-1	Clostridium difficile, toxin gene(s), amplified probe technique	CCI MUE	$ 37.27
Solana C. difficile	Unformed stool	87493	54067-4	Clostridium difficile, toxin gene(s), amplified probe technique	CCI MUE	$ 37.27

Group B Strep

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Solana GBS	Vaginal/Rectal Swab	87077	91875-5	Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate	CCI MUE	$ 8.08
		87653		Streptococcus, group B, amplified probe technique	CCI MUE	$ 35.09
				If all tests are ordered, performed, and reported:		$ 43.17

HSV/VZV

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Lyra Direct HSV 1+2/VZV	Lesions	87529	86502-2	Herpes simplex virus, amplified probe technique	CCI MUE	$ 35.09
		87529-59		Herpes simplex virus, amplified probe technique	CCI MUE	$ 35.09
		87798		Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism	CCI MUE	$ 35.09
				If all tests are ordered, performed, and reported:		$105.27
Solana HSV 1+2/VZV	Lesions	87529	33027-4	Herpes simplex virus, amplified probe technique	CCI MUE	$ 35.09
		87529-59		Herpes simplex virus, amplified probe technique	CCI MUE	$ 35.09
		87798		Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism	CCI MUE	$ 35.09
				If all tests are ordered, performed, and reported:		$105.27

Influenza

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Lyra Influenza A+B	Nasopharyngeal Swab Nasal Swab	87502	48509-4	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	CCI MUE	$ 95.80
Solana Influenza A+B	Nasopharyngeal Swab Nasal Swab	87502	48509-4	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	CCI MUE	$ 95.80
Solana Influenza A+B with Solana RSV + hMPV	Nasopharyngeal Swab Nasal Swab	87631	80602-6	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	CCI MUE	$142.63

Parainfluenza Virus

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Lyra Parainfluenza Virus

Nasal Swab
Nasopharyngeal Swab

87631

60254-0

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

CCI MUE

$142.63

RSV + hMPV

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Lyra RSV + hMPV	Nasal Swab Nasopharyngeal Swab	87634	92881-2	respiratory syncytial virus, amplified probe technique	CCI MUE	$ 70.20
		87798-59		Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism	CCI MUE	$ 35.09
				If all tests are ordered, performed, and reported:		$105.29
Solana RSV + hMPV	Nasal Swab Nasopharyngeal Swab	87634	92881-2	respiratory syncytial virus, amplified probe technique	CCI MUE	$ 70.20
		87798-59		Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism	CCI MUE	$ 35.09
				If all tests are ordered, performed, and reported:		$105.29
Solana RSV + hMPV with Solana Influenza A+B	Nasal Swab Nasopharyngeal Swab	87631	80602-6	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	CCI MUE	$142.63

Strep A

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Lyra Direct Strep	Throat Swab	87651	60489-2	Streptococcus, group A, amplified probe technique	CCI MUE	$ 35.09
		87798		Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism	CCI MUE	$ 35.09
				If all tests are ordered, performed, and reported:		$ 70.18
Solana GAS	Throat Swab	87651	60489-2	Streptococcus, group A, amplified probe technique	CCI MUE	$ 35.09
Solana Strep Complete	Throat Swab	87651		Streptococcus, group A, amplified probe technique	CCI MUE	$ 35.09
		87798	49610-9	Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism	CCI MUE	$ 35.09
				If all tests are ordered, performed, and reported:		$ 70.18

Trichomonas

Test Name

CPT Code

LOINC Code(s)

CPT Code Description

National Medicare Coverage

Medicare Reimbursement

Solana Trichomonas

Vaginal Swab/Urine

87661

69937-1

Trichomonas vaginalis, amplified probe technique

CCI MUE

$ 35.09

For Medicare Clinical Laboratory Fee Schedule, go to www.cms.hhs.gov.

*QW modifier is added to report use of CLIA-waived test system(s) for Medicare/Medicaid claims.

CMS has set the effective date for the addition of the QW modifier with 87420 and 87430 as October 6, 2020 and an implementation date of July 6, 2021. That means Medicare/Medicaid have until July 6, 2021 to update their systems to accept the QW modifier with these codes. We recommend customers check with their payers prior to submitting claims to verify if their system has been updated.

Effective January 1, 2010, CPT 81025 DOES NOT require a QW modifier to be recognized as a waived test. Source: CMS Job Aid 6685.

This information is being provided as a reference, for informational purposes only, with no expressed or implied warranty and does not purport to provide legal or certified coding advice. Under Federal and State law, it is the individual provider's responsibility to determine appropriate coding, charges and claims for a particular service. Policies regarding appropriate coding and payment levels can vary greatly from payer to payer and change over time. Quidel Corporation strongly recommends that providers contact their contracted payers to determine appropriate coding and charge or payment levels prior to submitting claims.

The information contained in this website has been compiled by CodeMap, L.L.C. who remains solely responsible for its content. The information provided is for general educational purposes only and may not be conclusive or exhaustive. Reimbursement information does not indicate overage for these services. While every effort is made to ensure that all payment amounts and regulatory information is current and complete, it is the responsibility of each user to verify specific coverage and payment information with their Medicare contractors. Actual reimbursement for healthcare facilities will vary depending on local carrier coverage and payment policies. Recent changes in applicable law, regulations and interpretations may not be reflected in the information contained herein.

This website is a private website and is not associated, endorsed or authorized by the Department of Health and Human Services, the Center for Medicare and Medicaid Services or any other public or government organization or agency.

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09/22/2023 01:22:50 34.239.148.127