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:  

Rapid Diagnostics

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

Medicare Reimbursement
Triage® BNP
83880-QW*
42637-9
30934-4
Natriuretic peptide
  CCI   MUE  
$ 39.26
Triage BNP Test for the Beckman Coulter Access Family of Immunoassay Systems
83880
30934-4
Natriuretic peptide
  CCI   MUE  
$ 39.26
Triage Cardiac Panel
84484
42757-5
Troponin, quantitative
  CCI   MUE  
$ 12.47
82553
49551-5
Creatine kinase (CK), (CPK); MB fraction only
  CCI   MUE  
$ 11.55
83874
53833-0
Myoglobin
  CCI   MUE  
$ 12.92
If all tests are ordered, performed, and reported:
 
$ 36.94
Triage Cardiac Panel (CK-MB) using Test Select
82553
49551-5
Creatine kinase (CK), (CPK); MB fraction only
  CCI   MUE  
$ 11.55
Triage Cardiac Panel (CK-MB and Troponin)
84484
42757-5
Troponin, quantitative
  CCI   MUE  
$ 12.47
82553
49551-5
Creatine kinase (CK), (CPK); MB fraction only
  CCI   MUE  
$ 11.55
If all tests are ordered, performed, and reported:
 
$ 24.02
Triage Cardiac Panel (Myoglobin) using Test Select
83874
53833-0
Myoglobin
  CCI   MUE  
$ 12.92
Triage Cardiac Panel (Troponin)
84484
42757-5
Troponin, quantitative
  CCI   MUE  
$ 12.47
Triage D-Dimer
85379
15129-0
Fibrin degradation products, D-dimer; quantitative
  CCI   MUE  
$ 10.18


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

Medicare Reimbursement
QuickVue® Chlamydia
87810
45106-2
Infectious agent antigen detection by immunoassay with direct optical observation; Chlamydia trachomatis
  CCI   MUE  
$ 35.29


Coronavirus

FAQs about the FFCRA and CARES Acts
Test Name
CPT Code
LOINC Code(s)
CPT Code Description
National Medicare Coverage

Medicare Reimbursement
Sofia® 2 SARS Antigen FIA
COVID-19 Reimbursement Toolkit
87426-QW*
95209-3
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
  MUE  
TBD
Sofia® 2 Flu + SARS Antigen FIA
COVID-19 Reimbursement Toolkit
QW Effective/Implementation Dates
87428-QW*
95942-9
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B
 
TBD
QuickVue® SARS Rapid Antigen Test
QW Effective/Implementation Dates
87811-QW*
96119-3
Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
 
TBD


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

Medicare Reimbursement
InflammaDry®
Reimbursement Guidelines
ABN-MMP9 Form
First Eye
83516-QW*
Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method
  CCI   MUE  
$ 11.53
Second Eye
83516-QW+59*
Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method
  CCI   MUE  
$ 11.53
If all tests are ordered, performed, and reported:
 
$ 23.06
QuickVue Adenoviral conjunctivitis
Reimbursement Guidelines
87809-QW*
5834-7
Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus
  CCI   MUE  
$ 21.76


Fecal Occult Blood
Test Name
CPT Code
LOINC Code(s)
CPT Code Description
National Medicare Coverage

Medicare Reimbursement
QuickVue iFOB
Diagnostic
82274-QW*
29771-3
Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations
  CCI   MUE  
$ 15.92
Screening
G0328-QW*
5823-0
  CCI   MUE   NCD
$ 18.05


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

Medicare Reimbursement
QuickVue H. pylori
Whole Blood
86318-QW*
17859-0
Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip);
  CCI   MUE  
$ 18.09
Serum/Plasma
86318
22310-7
Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip);
  CCI   MUE  
$ 18.09
QuickVue TLI Campylobacter
87449
57768-4
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; multiple-step method, not otherwise specified, each organism
  CCI   MUE  
$ 11.98
QuickVue TLI H. pylori Stool Antigen
Stool Antigen
87338
17780-8
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool
  CCI   MUE  
$ 14.38
QuickVue TLI Lactoferrin
83630
40703-1
Lactoferrin, fecal; qualitative
  CCI   MUE  
$ 19.70


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

Medicare Reimbursement
Sofia® Influenza A+B FIA If practitioner orders results for both A and B:
Influenza A
87400
72365-0
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Influenza, A or B, each
  CCI   MUE  
$ 14.13
Influenza B
87400-59
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Influenza, A or B, each
  CCI   MUE  
$ 14.13
If all tests are ordered, performed, and reported:
 
$ 28.26
QuickVue Influenza A+B If practitioner orders results for both A and B:
Influenza A
87804-QW*
72366-8
Infectious agent antigen detection by immunoassay with direct optical observation; Influenza
  CCI   MUE  
$ 16.55
Influenza B
87804-QW+59*
Infectious agent antigen detection by immunoassay with direct optical observation; Influenza
  CCI   MUE  
$ 16.55
If all tests are ordered, performed, and reported:
 
$ 33.10
QuickVue Influenza
87804-QW*
72367-6
Infectious agent antigen detection by immunoassay with direct optical observation; Influenza
  CCI   MUE  
$ 16.55
Sofia® 2 Flu + SARS Antigen FIA
COVID-19 Reimbursement Toolkit
QW Effective/Implementation Dates
87428-QW*
95942-9
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B
 
TBD


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

Medicare Reimbursement
Sofia Lyme FIA
IgM
86618
79708-4
Antibody; Borrelia burgdorferi (Lyme disease)
  CCI   MUE  
$ 17.03
IgG
86618-59
Antibody; Borrelia burgdorferi (Lyme disease)
  CCI   MUE  
$ 17.03
Sofia 2 Lyme FIA
IgM
86618-QW*
30526-8
Antibody; Borrelia burgdorferi (Lyme disease)
  CCI   MUE  
$ 17.03
IgG
86618-QW+59*
Antibody; Borrelia burgdorferi (Lyme disease)
  CCI   MUE  
$ 17.03


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

Medicare Reimbursement
QuickVue+® Mononucleosis
Whole Blood
86308-QW*
69420-8
Heterophile antibodies; screening
  CCI   MUE  
$ 5.18
Serum/Plasma
86308
6425-3
Heterophile antibodies; screening
  CCI   MUE  
$ 5.18


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

Medicare Reimbursement
Sofia hCG FIA
Urine
84703
2112-1
Gonadotropin, chorionic (hCG); qualitative
  CCI   MUE  
$ 7.52
QuickVue hCG Urine
Urine
81025
2106-3
Urine pregnancy test, by visual color comparison methods
  CCI   MUE  
$ 8.61
QuickVue hCG Combo
Urine
81025
2106-3
Urine pregnancy test, by visual color comparison methods
  CCI   MUE  
$ 8.61
Serum
84703
2118-8
Gonadotropin, chorionic (hCG); qualitative
  CCI   MUE  
$ 7.52
QuickVue+ hCG Combo
Urine
81025
2106-3
Urine pregnancy test, by visual color comparison methods
  CCI   MUE  
$ 8.61
Serum
84703
2118-8
Gonadotropin, chorionic (hCG); qualitative
  CCI   MUE  
$ 7.52


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

Medicare Reimbursement
Sofia RSV FIA
patients 7-under 19
87807
32040-8
Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus
  CCI   MUE  
$ 13.10
patients less than 7 years
87807-QW*
32040-8
Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus
  CCI   MUE  
$ 13.10
QuickVue RSV
87807-QW*
72885-7
Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus
  CCI   MUE  
$ 13.10
QuickVue RSV 10
87807
72885-7
Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus
  CCI   MUE  
$ 13.10


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

Medicare Reimbursement
Sofia Strep A FIA
87880
6557-3
Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A
  CCI   MUE  
$ 16.53
Sofia Strep A+ FIA
87880-QW*
6557-3
Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A
  CCI   MUE  
$ 16.53
QuickVue Dipstick Strep A
87880-QW*
6556-5
Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A
  CCI   MUE  
$ 16.53
QuickVue In-Line® Strep A
87880-QW*
6556-5
Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A
  CCI   MUE  
$ 16.53
QuickVue+ Strep A
87880
6556-5
Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A
  CCI   MUE  
$ 16.53


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

Medicare Reimbursement
Triage® TOX Drug Screen, 94600
80307
3299-5
14308-1
19270-8
14316-4
19359-9
19550-3
19554-5
19295-5
14310-7
19312-8
14312-3
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service
  CCI   MUE  
$ 62.14
Triage® Visual 3-Drug Panel BUP, MDMA, OXY
80305
BUP
91027-3
OXY
19642-8
MDMA
19568-5
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service
  CCI   MUE  
$ 12.60
Triage® Visual Rapid PCP Single Test
80305
19659-2
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service
  CCI   MUE  
$ 12.60




  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 06:54:16 3.230.76.48