Medicare Coverage for Zika Virus Testing
August 25, 2016In the U.S, the Centers for Disease Control and Prevention (CDC) considers the Zika virus disease to be a nationally notifiable condition. Currently, there are a few diagnostic tests that can determine the presence of the virus, and these are available through the CDC and certain CDC-approved health laboratories. In addition, a small number of tests have been released on an emergency basis to commercial laboratories. Coverage is available through Medicare Part B for clinical diagnostic laboratory tests that are reasonable and necessary for the diagnosis or treatment of a person’s illness or injury. This means that testing for the Zika virus may be considered medically necessary when a beneficiary’s clinical history and symptoms indicate the possibility of infection with the virus. Coverage for this testing is not available on a screening basis, but only for situations in which there is valid medical reason to suspect Zika infection. Providers billing for Zika viral testing may submit claims using the following codes: CPT Code 87798 (infectious agent detection by nucleic acid (DNA or RNA), NOS; amplified probe technique, each organism); ICD-10 Code A92.9 (through 9/30/2016) and ICD-10 Code A92.5 (10/1/2016 and thereafter).