CPT Code 86413 Reimbursement Rate Update

October 16, 2020

Effective for dates of service on or after September 8, 2020, the Department of Health Care Services (DHCS) updated the reimbursement rate for CPT® code 86413 (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)] antibody, quantitative).

DHCS established the reimbursement rate at 100 percent of the Medicare rate for 86413. This code 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 (AB) 97 payment reduction.

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

The updated manual pages reflecting this change will be released in a future Medi-Cal Update.