CodeMap®-Quidel Coding Reference

2022 Coding Reference

For questions, please contact CodeMap Reimbursement Support at (312) 291-8408
or email quidel@codemap.com

Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes

No payment adjustment through March 31, 2022
1% payment adjustment April 1 - June 30, 2022
2% payment adjustment beginning July 1, 2022
Source

Rapid Diagnostics	Molecular Diagnostics	Cell Culture & Fluorescent Tests	ELISA
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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 SARS CoV-2	U0003	94559-2	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, making use of high throughput technologies as described by cms-2020-01-r CMS-2020-1-R1	CCI MUE	$ 75.00
Lyra SARS CoV-2	U0005		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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 CMS-2020-1-R2	MUE	$ 25.00
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
Lyra Direct SARS CoV-2	U0003	94559-2	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, making use of high throughput technologies as described by cms-2020-01-r CMS-2020-1-R1	CCI MUE	$ 75.00
Lyra Direct SARS CoV-2	U0005		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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 CMS-2020-1-R2	MUE	$ 25.00
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
Solana® SARS-CoV-2 Assay	U0003	94559-2	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, making use of high throughput technologies as described by cms-2020-01-r CMS-2020-1-R1	CCI MUE	$ 75.00
Solana® SARS-CoV-2 Assay	U0005		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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 CMS-2020-1-R2	MUE	$ 25.00

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 providerÕs 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.

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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06/26/2022 03:19:26 3.235.78.122