Respiratory Viral Panel Policy - Did You Know

Noridian, your Medicare Administrative Contractor (MAC) published a Local Coverage Determination (LCD) that became effective last October 1, 2019.

The MolDX Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels (L37301) LCD allows the coverage of panels up to five (5) pathogens. Reference the Billing and Coding article (A57338) to view covered billing codes listed in Group 1 using the link below. CPT codes 87632 and 87633 are listed in Group 2 non-covered codes. Even though you may choose to use a test kit with more pathogens, Noridian will only cover up to five pathogens.

The correct CPT code is 87631 (Infectious agent detection by nucleic acid (DNA OR RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe techniques, multiple types or subtypes, 3-5 targets), covered for up to five (5) pathogens. The test kit must be ordered either in a healthcare setting that is equipped to care for and routinely does care for critically ill patients, or it must be ordered by an infectious disease specialist, unless an infectious disease specialist is not available.

References:

LCD: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=37315&ContrId=345

Article: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=57340

            Last Updated Thu, 15 Oct 2020 15:05:49 +0000