If you would like to extend your session, you may select the Continue Button. The Solution. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). The Medicare National Limit amount* is $16.36. A patient has had recent close exposure (this does NOT include eating cooked meat) to pigs or birds (including poultry) or other animals, and there is concern for infection with a novel influenza A virus. Another option is to use the Download button at the top right of the document view pages (for certain document types). In some cases, additional time should be accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the CPT codes, descriptions and other data only are copyright 2022 American Medical Association. I disagree with -91, as the test is not technically being repeated. The AMA assumes no liability for data contained or not contained herein. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom A patient has had recent close exposure (this does NOT include eating cooked meat) to pigs or birds (including poultry) or other animals, and there is concern for infection with a novel influenza A virus. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. Intended for the qualitative detection ofinfluenza type A and type B nucleoproteinantigens directly from nasal andnasopharyngeal swab specimens frompatients with signs and symptoms ofrespiratory infection. Absence of a Bill Type does not guarantee that the By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. The sensitivity values of the kit were 97.5%, 97.9%, and 33.33% for SARS-CoV-2, IAV, and IBV, respectively, in samples with a viral load below 20 Ct values. RT-PCR or other amplification methods to detect viral nucleic acids, Results available in < 24 hours (often in less than 2-4 hours), Detects from 1-2 to up to 20 respiratory pathogens from 1 specimen. Accessed 4/27/21. If a CLIA-waived test is performed, the -QW modifier should be reported for the waived test. Before sharing sensitive information, make sure you're on a federal government site. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. COVID-19/Flu A&B . As laboratory tests, Medicare will cover these codes at 100% of their allowed amount with no deductible or coinsurance applied. Concurrent detection promises to conserve important testing resources, allowing for ongoing surveillance of influenza while testing for the novel coronavirus.. Follow manufacturers instructions, including handling of respiratory specimens, as described in the device package insert. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. "JavaScript" disabled. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Administration of influenza virus vaccine (allowable same as CPT 90471) 90653: Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use: 90662: Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use: 90672 352 0 obj <>stream 0 In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Information for Clinicians on Rapid Diagnostic Testing for Influenza. Unless specified in the article, services reported under other Sign up to get the latest information about your choice of CMS topics in your inbox. Instructions for enabling "JavaScript" can be found here. The views and/or positions * For positive Flu only or RSV only. Reproduced with permission. that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. Neither the United States Government nor its employees represent that use of such information, product, or processes The Sofia Influenza A+B Fluorescent Immunoassay (FIA) uses advanced immunofluorescence-based lateral-flow technology to detect influenza A and influenza B viral nucleoprotein antigens. AHA copyrighted materials including the UB‐04 codes and Kidney disease can be prevented, and even reversed in its early stages. If a rapid antigen test is performed and then confirmed using PCR, the second test may require the -59 modifier. Current Dental Terminology © 2022 American Dental Association. ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, Information for Clinicians on Rapid Diagnostic Testing for Influenza, VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE IDENTIFICATION BY CYTOPATHIC EFFECT, VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE IDENTIFICATION (EG, HEMABSORPTION, NEUTRALIZATION, IMMUNOFLUORESCENCE STAIN), EACH ISOLATE, VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL) TECHNIQUE, INCLUDES IDENTIFICATION WITH IMMUNOFLUORESCENCE STAIN, EACH VIRUS, INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B VIRUS, INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA A VIRUS, 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; INFLUENZA, A OR B, EACH, INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, INCLUDES REVERSE TRANSCRIPTION, WHEN PERFORMED, AND AMPLIFIED PROBE TECHNIQUE, EACH TYPE OR SUBTYPE, 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, 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), INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL (IE, VISUAL) OBSERVATION; INFLUENZA. Similarly, tests (and CPT codes) for which there are no accompanying ICD-10 codes in the associated Billing and Coding Article will require registration with MolDX . The HOD speakers welcome comments for reports under development for the upcoming Interim and Annual Meetings. AMA members get discounts on prep courses and practice questions. Some minor issues are listed as follows. Do not freeze specimens. Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). Rapid qualitative test that detects Influenza type A and type B antigens directly from nasal swab, nasopharyngeal swab, and Nasopharyngeal aspirate / wash specimens. That's why we've developed Alinity TM m Resp-4-Plex, a new assay running on our advanced Alinity m system that tests for COVID-19, flu A, flu B, and RSV using only one swab. End Users do not act for or on behalf of the CMS. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. without the written consent of the AHA. Description. NPA* (versus an FDA-cleared influenza A and B molecular assay) A: 97.8%, B: 99.1%. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not Tests will be run in the order of receipt only, tests remaining at the end of each shift will be reordered under NCVQLT for transport to UW Virology. Harmon MW, Kendal AP. There are multiple ways to create a PDF of a document that you are currently viewing. The CMS.gov Web site currently does not fully support browsers with Local Coverage Articles are a type of educational document published by the Medicare Administrative Contractors (MACs). Medicare contractors are required to develop and disseminate Articles. Please do not use this feature to contact CMS. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. You can use the Contents side panel to help navigate the various sections. Collect respiratory tract specimens as early in the illness as possible (within 3-4 days of illness onset). Learn more about the process with the AMA. FDA) now requires that all Rapid influenza diagnostic tests (RIDTs) achieve 80% or higher sensitivity compared with RT-PCR. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. Point-of-care tests for influenza Large number on the market - some separate influenza A from influenza B - some specific for influenza H5 Detect either antigen or neuraminidase activity Vary in the number of steps (4-8) and in the time to perform the test (10-30 mins) Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Centers for Disease Control and Prevention (CDC) recommendations: Use rapid diagnostic tests with high sensitivity and specificity. The association also released CPT codes for two antigen tests for the COVID-19 . Instructions for enabling "JavaScript" can be found here. Rapid Test Kit McKesson Consult Infectious Disease Immunoassay Influenza A + B Nasal Swab / Nasopharyngeal Wash / Nasopharyngeal Aspirate Sample 25 Tests CLIA Waived. The physician makes the determination to run both influenza A and B tests and a rapid . The FDA has authorized the first nonprescription diagnostic test that can identify multiple viruses that cause COVID-19-like respiratory symptoms, including respiratory syncytial virus (RSV). FDA officials see it as another step toward diagnostic testing at home for certain viruses. An official website of the United States government. MODIFIER -59 IS USED TO IDENTIFY PROCEDURES/SERVICES THAT ARE NOT NORMALLY REPORTED TOGETHER, BUT ARE APPROPRIATE UNDER THE CIRCUMSTANCES. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". The Alinity m Resp-4-Plex assay was validated with nasopharyngeal swabs. If a CLIA-waived test is performed, the -QW modifier should be reported for the waived test. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. ICD-9 code for sports physicals. Data for the 2017 to 2018 influenza season indicates that 84.1 percent of positive samples were influenza A, while 15.9 percent were influenza B. Draft articles have document IDs that begin with "DA" (e.g., DA12345). 87426 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]). When we billed Medicare for both of these CPTs they were denied . During the exam, the physician observes swollen and red tonsils. THIS MAY REPRESENT A DIFFERENT SESSION OR PATIENT ENCOUNTER, DIFFERENT PROCEDURE OR SURGERY, DIFFERNET SITE OR ORGAN SYSTEM, SEPARATE INCISION/EXCISION, SEPARATE LESION, OR SEPARATE INJURY (OR AREA OF INJURY IN EXTENSIVE INJURIES) NOT ORDINARILY ENCOUNTERED OR PERFORMED ON THE SAME DAY BY THE SAME PHYSICIAN. Veritor System for Rapid Detection of Flu A + B Product Insert, Table 2 (U.S. Sites) endstream endobj startxref R5. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. PPA* (versus an FDA-cleared influenza A and B molecular assay) A: 81.5%, B: 80.9%. No fee schedules, basic unit, relative values or related listings are included in CPT. THE UNITED STATES Before sharing sensitive information, make sure you're on a federal government site. End User License Agreement: End Users do not act for or on behalf of the CMS. ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, Information for Clinicians on Rapid Diagnostic Testing for Influenza, VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE IDENTIFICATION BY CYTOPATHIC EFFECT, VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE IDENTIFICATION (EG, HEMABSORPTION, NEUTRALIZATION, IMMUNOFLUORESCENCE STAIN), EACH ISOLATE, VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL) TECHNIQUE, INCLUDES IDENTIFICATION WITH IMMUNOFLUORESCENCE STAIN, EACH VIRUS, INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B VIRUS, INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA A VIRUS, 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; INFLUENZA, A OR B, EACH, INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, INCLUDES REVERSE TRANSCRIPTION, WHEN PERFORMED, AND AMPLIFIED PROBE TECHNIQUE, EACH TYPE OR SUBTYPE, 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, 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), INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL (IE, VISUAL) OBSERVATION; INFLUENZA. 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