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Delayed Implementation: CLIA-Waived Benefit for HIV-1 and HIV-2 Testing Code

September 20, 2016

The article below first appeared in the August 2016 Medical Update. The related policy implementation will be delayed until October 25, 2016.

    Effective retroactively for dates of service on or after October 1, 2015, CPT-4 code 87806 (infectious agent antigen detection by immunoassay with direct optical observation; HIV-1 antigen[s], with HIV-1 and HIV-2 antibodies) may be billed as a Clinical Laboratory Improvement Amendments (CLIA)-waived test. Modifier QW is allowed, but not required for reimbursement of CPT-4 code 87806. As a reminder, this code is not split-billable, and should not be billed with modifier 26 or TC.

    An Erroneous Payment Correction (EPC) will be initiated to reprocess affected claims.