IHCP to Allow CLIA Certificate of Waiver for CPT Code 86328, Accept Resubmitted Claims

Effective immediately, the FFS claim-processing system (CoreMMIS) has been updated for Current Procedural Terminology (CPT®1) code 86328 – Test for detection of severe acute respiratory syndrome coronavirus 2 (COVID-19) antibody, qualitative or semiquantitative. Procedure code 86328 was considered a CLIA-waived test as of Sept. 23, 2020. Claims for this code with dates of service (DOS) on or after Sept. 23, 2020, will be billable by laboratories that have a valid CLIA certificate of waiver. CoreMMIS has been updated to classify CPT code 86328 as a CLIA-waived test.

FFS claims for procedure code 86328 billed by providers with valid CLIA certificates of waiver may have denied inappropriately with explanation of benefits (EOB) 4207 – Effective CLIA number not on file for dates of service billed. Beginning immediately, laboratory providers may resubmit claims for code 86328 with DOS on or after Sept. 23, 2020, that denied for EOB 4207, for reimbursement consideration. Claims resubmitted beyond the original filing limit must include a copy of this banner page as an attachment. Claims must be resubmitted within 180 days of this banner page’s publication date.