New Benefit for COVID-19 Detection

December 14, 2020

Effective for dates of service on or after November 10, 2020, CPT® code 87428 (infectious agent antigen detection by immunoassay technique, [eg, enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay (FIA), immunochemiluminometric assay (IMCA)] qualitative or semiquantitative; severe acute respiratory syndrome coronavirus [eg, SARS-CoV, SARS-CoV-2 (COVID-19)] and influenza virus types A and B) is a Medi-Cal benefit. The frequency limit for code 87428 is once per day, any provider. Code 87428 is reimbursable for Presumptive Eligibility for Pregnant Women (PE4PW) services.

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

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