Infectious Agent Detection by Nucleic Acid

When using nucleic acid amplification techniques to test for a single infectious organism that lacks a specific CPT code in the 87470-87660 range, billing a single unit of CPT code 87798 is appropriate.  When nucleic acid amplification techniques are used to test for more than one infectious organism in a specimen, whether or not a specific CPT code in the 87470-87660 range is available (such as in an infectious disease panel), billing a single unit of CPT code 87801 is appropriate. OHCA has determined that billing multiple units of CPT code 87798 rather than a single unit of 87801 has led to incorrect reimbursement of services, denial of services, overpayments, and recoupments.  OHCA will allow only one unit of 87798 or 87801 for single or multiple-organism tests, respectively, to ensure that infectious disease testing services are paid appropriately. CPT codes 87631-87633 were introduced in 2013 for procedures that detect multiple respiratory viruses in a single multiplex reaction.  These codes are not covered services at this time.