Sunday, April 12, 2020

AMA Creates CPT Code for COVID Serology; PLUS, AMA Lists CMS COVID Regulatory Actions

Background - COVID PCR Codes

Back in early March, CMS created two new COVID codes, one for the CDC test and one for all other tests, any methods.  CMS priced the codes at about $30 and $50, respectively (U0001, U0002).  By mid-March, AMA CPT had jumped on board, and created an AMA code for COVID test, 87635, any amplified method (entry point here). 

New News:  AMA CPT Serology Codes

New news.  AMA has now created two codes for COVID serology. 

  • The first code, 86328, is for COVID immunoassay, single step e.g. reagent strip (laminar flow; think pregnancy test).   
  • The second code, 86769, is for any other COVID serology method.   Note the two numbers are not serial.  
  • AMA does not price codes, but expect CMS to release pricing in coming days.  

See the AMA press release about 86328/86 here.

For a range of mid-April newspaper and policy links on serology implementation, here.

Interaction with CARES Legislation

As I noted in early April, CARES legislation defines COVID tests as covered tests and defines payment rules (here; CARES Act, sections 3201, 3202, 3203).   This covers "detection of SARS-CoV-2" and a serology test detects response to CoV-2 rather than detecting CoV-2.  I'm not sure if the CARES legislation could be reasonably read to include serology tests, or if it would be very narrowly read to not include serology tests. 


AMA Releases Long Summary of CMS COVID Updates

On April 11, AMA released a pretty long summary and resource guide to CMS updates for COVID (e.g. loosened telemedicine rules). 

  • Find the AMA website for CMS updates, here.