Reimbursement Rates are Updated for COVID-19 Testing

October 5, 2020

Effective for dates of service on or after August 10, 2020, CPT® codes 86408 (neutralizing antibody, severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)]; screen) and 86409 (neutralizing antibody, severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)]; titer) have updated reimbursement rates.

Additionally, the Department of Health Care Services (DHCS) is establishing the reimbursement rates at 100 percent of the Medicare rate for 86408 and 86409. These codes are 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, these rates 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.

Updated rates are as follows:
Codes Description Medicare Rate
86408 Neutralizing antibody, (SARSCoV-2), screen $42.13
86409 Neutralizing antibody, (SARSCoV-2), titer $79.61

 

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