Infectious Agent Antigen Detection by Immunoassay Reimbursement Rate

December 17, 2020

Effective for dates of service on or after November 10, 2020, the Medicare rate for 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) has been established.

Additionally, code 87428 is exempt from the ten percent payment reduction 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 affected claims.