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CMS Flexibilities to Fight COVID-19 – COVID-19, Influenza, and RSV Clinical Diagnostic Laboratory Tests for which Medicare Does Not Require a Practitioner Order During the PHE


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COVID-19, Influenza, and RSV Clinical Diagnostic Laboratory Tests for which
Medicare Does Not Require a Practitioner Order During the PHE*
Updated May 12, 2020
CPT/HCPCS
Code Laboratory Code Long Descriptor
Code
Category
COVID-19 Related Codes
U0001 CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel COVID-19
U0002
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or
subtypes (includes all targets), non-CDC)
COVID-19
U0003
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), 2 amplified probe technique, making
use of high throughput technologies as described by CMS-2020-01-R
COVID-19
U0004
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or
subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by
CMS-2020-01-R
COVID-19
87635
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
COVID-19
86769
Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease
[COVID-19])
COVID-19
86328
Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method
(eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus
disease [COVID-19])
COVID-19
Influenza/RSV Related Codes
87275 Infectious agent antigen detection by immunofluorescent technique; influenza B virus Influenza/RSV
87276 Infectious agent antigen detection by immunofluorescent technique; influenza A virus Influenza/RSV
87279 Infectious agent antigen detection by immunofluorescent technique; Parainfluenza virus, each type Influenza/RSV
5/12/2020
87400
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
Influenza/RSV
87501
Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, includes reverse transcription, when performed, and amplified probe technique, each type or subtype
Influenza/RSV
87502
Infectious agent detection by nucleic acid (DNA or RNA); 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
Influenza/RSV
87503
Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond 2 (List separately in addition to code for primary procedure)
Influenza/RSV
87631
Infectious agent detection by nucleic acid (DNA or RNA); 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
Influenza/RSV
87632
Infectious agent detection by nucleic acid (DNA or RNA); 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, 6-11 targets
Influenza/RSV
87633
Infectious agent detection by nucleic acid (DNA or RNA); 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, 12-25 targets
Influenza/RSV
87804
Infectious agent antigen detection by immunoassay with direct optical observation; Influenza
Influenza/RSV
87280
Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus
Influenza/RSV
87420
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; respiratory syncytial virus
Influenza/RSV
5/12/2020
87634
Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus, amplified probe technique
Influenza/RSV
87807
Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus
Influenza/RSV

  • Other Medicare conditions of coverage and payment continue to apply, including any applicable local coverage determinations.
CMS Flexibilities to Fight COVID-19 – COVID-19, Influenza, and RSV Clinical Diagnostic Laboratory Tests for which Medicare Does Not Require a Practitioner Order During the PHE

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