COVID-19 Antibody Testing Codes 2020

The American Medical Association (AMA) announced, on September 4,2019, the release of the 2020 Current Procedural Terminology (CPT®) code set containing identifiers and descriptors assigned to each medical, surgical, and diagnostic services available to patients. An integral and trusted resource for the health system’s common language of healthcare medical services and procedures since 1966, the CPT code set enables accurate reporting, measurement, analysis, and benchmarking of medical services and procedures across the Nation’s entire health care system.

Antibody tests developed for the purpose of determining who has developed an immune response to COVID-19 are playing a significant role in helping medical professionals quantify the actual scope of impact the virus has on the population so one day we can resume “normal” activities. The American Medical Association (AMA) has provided CPT updates that include two new codes for COVID-19 antibody tests, effective April 10, 2020:

  • 86328 – Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).
  • 86769 – Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).

Typically a strip with all the necessary components for the assay, appropriate for a point-of-care testing platform, Code 86328 should be used for antibody tests with a single-step method immunoassay. Report 86328 once per reagent strip. If more than one reagent strip is used, modifier 59 (distinct procedural service) should be appended to the code for the second reagent strip assay to show and record that two distinct analyses were performed.

Code 86769 should be used for antibody tests with multi-step methods. When two distinct analyses are performed (examples being IgG and IgM), 86769 is reported on two claim lines with modifier 59 (distinct procedural service) appended to 86769 on the second claim line.

Blood sample collections are reported with CPT code 36415 (Collection of venous blood by venipuncture) or 36416 (Collection of capillary blood specimen, (such as ear stick,heel, and finger).

Although there are many tests being marketed right now, as of April 18, 2020, the Food and Drug Administration (FDA) had approved only four effective tests for detecting COVID-19 antibodies. Each of the four tests have been approved under the FDA’s emergency authorization program. The antibody test codes come very shortly after the creation of a new CPT code for COVID-19 diagnostic testing instituted in May, 2020:

  • 87635 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.

The AMA has more information about the new codes here. Additionally, the AMA’s CPT Assistant is providing two fact sheets for coding guidance for the SARS-CoV-2 (COVID-19) test in relation to the use of the new CPT codes. You can find both the March 13 fact sheet and April 10 fact sheet on the AMA website.

Lastly, the Centers for Medicare & Medicaid Services first issued new HCPCS codes for COVID-19 testing last month, and has since added addtional codes released last week by the CMS.