2021 Coding Reference

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

Rapid & Molecular Reimbursement Summary

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.


Rapid Diagnostics

Molecular Diagnostics

Cell Culture & Fluorescent Tests

ELISA
Please select your state:  

Molecular Diagnostics

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
AmpliVue® Bordetella
Nasopharyngeal Swab
87798
43913-3
Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism
  CCI   MUE  
$ 35.09
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  
TBD
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
  MUE  
$ 75.00
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
 
$ 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  
TBD
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
  MUE  
$ 75.00
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
 
$ 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  
TBD
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
  MUE  
$ 75.00
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
 
$ 25.00


Gastrointestinal
Test Name
CPT Code
LOINC Code(s)
CPT Code Description
National Medicare Coverage

Medicare Reimbursement
AmpliVue C. difficile
Unformed stool
87493
54067-4
Clostridium difficile, toxin gene(s), amplified probe technique
  CCI   MUE  
$ 37.27
EntericBio® Dx GI Panel 5
Unformed stool
87505
79381-0
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  
$128.29
EntericBio Dx GI Panel 7
Unformed stool
87506
79381-0
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  
$262.99
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
AmpliVue 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
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
AmpliVue HSV 1+2
Lesions
87529
87431-3
Herpes simplex virus, amplified probe technique
  CCI   MUE  
$ 35.09
87529-59
Herpes simplex virus, amplified probe technique
  CCI   MUE  
$ 35.09
If all tests are ordered, performed, and reported:
 
$ 70.18
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.

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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04/14/2021 05:57:38 3.230.76.48