2021 Coding Reference
For questions, please contact CodeMap Reimbursement Support at (312) 291-8408 or email quidel@codemap.com
Rapid & Molecular Reimbursement Summary
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The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended
the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1
through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends
the suspension period to March 31, 2021.
Click here for more information.
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Molecular Diagnostics
Adenovirus
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
Lyra® Adenovirus |
Nasal Swab |
87798 |
76070-2
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
Bordetella
Test Name |
|
CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
AmpliVue® Bordetella |
Nasopharyngeal Swab |
87798 |
43913-3
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
Solana® Bordetella Complete |
Nasopharyngeal Swab |
87798 |
90441-7
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
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87798-59 |
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$ 70.18
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Coronavirus
FAQs about the FFCRA and CARES Acts
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
Lyra SARS CoV-2 |
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87635 |
94559-2
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severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique |
CCI
MUE
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TBD
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Lyra SARS CoV-2 |
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U0003 |
94559-2
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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
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MUE
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$ 75.00 |
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U0005 |
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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
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$ 25.00 |
Lyra Direct SARS CoV-2 |
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87635 |
94559-2
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severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique |
CCI
MUE
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TBD
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Lyra Direct SARS CoV-2 |
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U0003 |
94559-2
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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
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MUE
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$ 75.00 |
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U0005 |
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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
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$ 25.00 |
Solana® SARS-CoV-2 Assay |
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87635 |
94559-2
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severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique |
CCI
MUE
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TBD
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Solana® SARS-CoV-2 Assay |
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U0003 |
94559-2
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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
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MUE
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$ 75.00 |
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U0005 |
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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
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$ 25.00 |
Gastrointestinal
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
AmpliVue C. difficile |
Unformed stool |
87493 |
54067-4
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Clostridium difficile, toxin gene(s), amplified probe technique |
CCI
MUE
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$ 37.27 |
EntericBio® Dx GI Panel 5 |
Unformed stool |
87505 |
79381-0
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gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets |
CCI
MUE
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$128.29 |
EntericBio Dx GI Panel 7 |
Unformed stool |
87506 |
79381-0
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gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets |
CCI
MUE
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$262.99 |
Lyra Direct C. difficile |
Unformed stool |
87493 |
80685-1
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Clostridium difficile, toxin gene(s), amplified probe technique |
CCI
MUE
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$ 37.27 |
Solana C. difficile |
Unformed stool |
87493 |
54067-4
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Clostridium difficile, toxin gene(s), amplified probe technique |
CCI
MUE
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$ 37.27 |
Group B Strep
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
AmpliVue GBS |
Vaginal/Rectal Swab |
87077 |
91875-5
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Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate |
CCI
MUE
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$ 8.08 |
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87653 |
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Streptococcus, group B, amplified probe technique |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$ 43.17
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Solana GBS |
Vaginal/Rectal Swab |
87077 |
91875-5
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Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate |
CCI
MUE
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$ 8.08 |
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87653 |
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Streptococcus, group B, amplified probe technique |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$ 43.17
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HSV/VZV
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
AmpliVue HSV 1+2 |
Lesions |
87529 |
87431-3
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Herpes simplex virus, amplified probe technique |
CCI
MUE
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$ 35.09 |
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87529-59 |
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Herpes simplex virus, amplified probe technique |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$ 70.18
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Lyra Direct HSV 1+2/VZV |
Lesions |
87529 |
86502-2
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Herpes simplex virus, amplified probe technique |
CCI
MUE
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$ 35.09 |
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87529-59 |
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Herpes simplex virus, amplified probe technique |
CCI
MUE
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$ 35.09 |
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87798 |
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$105.27
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Solana HSV 1+2/VZV |
Lesions |
87529 |
33027-4
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Herpes simplex virus, amplified probe technique |
CCI
MUE
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$ 35.09 |
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87529-59 |
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Herpes simplex virus, amplified probe technique |
CCI
MUE
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$ 35.09 |
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87798 |
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$105.27
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Influenza
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
Lyra Influenza A+B |
Nasopharyngeal Swab
Nasal Swab |
87502 |
48509-4
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influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub-types |
CCI
MUE
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$ 95.80 |
Solana Influenza A+B |
Nasopharyngeal Swab
Nasal Swab |
87502 |
48509-4
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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
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$ 95.80 |
Solana Influenza A+B with Solana RSV + hMPV |
Nasopharyngeal Swab
Nasal Swab |
87631 |
80602-6
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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
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$142.63 |
Parainfluenza Virus
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
Lyra Parainfluenza Virus |
Nasal Swab
Nasopharyngeal Swab |
87631 |
60254-0
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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
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$142.63 |
RSV + hMPV
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
Lyra RSV + hMPV |
Nasal Swab
Nasopharyngeal Swab |
87634 |
92881-2
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respiratory syncytial virus, amplified probe technique |
CCI
MUE
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$ 70.20 |
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87798-59 |
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$105.29
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Solana RSV + hMPV |
Nasal Swab
Nasopharyngeal Swab |
87634 |
92881-2
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respiratory syncytial virus, amplified probe technique |
CCI
MUE
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$ 70.20 |
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87798-59 |
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$105.29
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Solana RSV + hMPV with Solana Influenza A+B |
Nasal Swab
Nasopharyngeal Swab |
87631 |
80602-6
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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
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$142.63 |
Strep A
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
Lyra Direct Strep |
Throat Swab |
87651 |
60489-2
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Streptococcus, group A, amplified probe technique |
CCI
MUE
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$ 35.09 |
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87798 |
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$ 70.18
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Solana GAS |
Throat Swab |
87651 |
60489-2
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Streptococcus, group A, amplified probe technique |
CCI
MUE
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$ 35.09 |
Solana Strep Complete |
Throat Swab |
87651 |
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Streptococcus, group A, amplified probe technique |
CCI
MUE
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$ 35.09 |
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87798 |
49610-9
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Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
CCI
MUE
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$ 35.09 |
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If all tests are ordered, performed, and reported: |
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$ 70.18
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Trichomonas
Test Name |
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CPT Code |
LOINC Code(s) |
CPT Code Description |
National Medicare Coverage |
Medicare Reimbursement |
Solana Trichomonas |
Vaginal Swab/Urine |
87661 |
69937-1
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Trichomonas vaginalis, amplified probe technique |
CCI
MUE
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$ 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.
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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CPT copyright 2020 American Medical Association. All rights reserved.
CodeMap® is a Registered Trademark of Wheaton Partners, LLC. |
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04/14/2021 05:57:38 3.230.76.48
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