CPT Code for COVID-19 Testing Exempt from AB 97 10 Percent Payment Reduction

August 27, 2020

Effective for dates of service on or after June 25, 2020, the American Medical Association created CPT® code 87426 (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)]) for reporting antigen testing of patients suspected of being infected with the coronavirus disease 2019 (COVID-19).

Additionally, the Department of Health Care Services (DHCS) is establishing the reimbursement rate at 100 percent of the Medicare rate for the new code. It is exempt from the ten percent payment reductions in Welfare and Institutions Code (W&I Code) Section 14105.192.

Upon expiration of the public health emergency or national emergency, this rate will be amended to correspond with the clinical laboratory services methodology in W&I Code Section 14105.22, including the application of the Assembly Bill 97 (AB 97) payment reduction.

An erroneous payment correction (EPC) will be implemented to reprocess the affected claims.