Rates Are Updated for CPT COVID-19 Testing Codes 87636, 87637 and 87811
December 8, 2020
Effective for dates of service on or after October 6, 2020, the rates for CPT® codes 87636 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)] and influenza virus types A and B, multiplex amplified probe technique), 87637 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)], influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique) and 87811 (infectious agent antigen detection by immunoassay with direct optical [ie, visual] observation; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)]) are updated.
| Codes |
Description |
Medicare Rate |
| 87636 |
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique |
$142.63 |
| 87637 |
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique |
$142.63 |
| 87811 |
Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respirator syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) |
$41.38 |
The codes above are exempt from the 10% payment reductions in Welfare and Institutions (W&I) Code section 14105.192, as described in Attachment 4.19-B, page 3.3, paragraph 13 of the State Plan.
An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.
