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CPT Codes for COVID-19 Specific Antibody Test

The world is caught up in the Coronavirus-led pandemic and everyone is trying their hardest, especially the medical research community in fighting this virus, tooth and nail.

One of the biggest breakthroughs has been fighting the infection in patients using antibodies from the people who have already recovered from COVID-19.

We know how our bodies develop antibodies when they fight against infections. Similarly, when we take a vaccination, like a flu shot, the same thing occurs in the body, and we are able to boost our immunity against the same infection.

So, the antibody test ​is to screen antibodies, and not the virus, in the bloodstream. It is to see whether your body’s defense against the infection – your immune system – has responded to Coronavirus.

If you have been fully recovered from COVID-19, you could help patients who are currently fighting the disease by donating your plasma.

How Does This Work?

Just like a regular blood test, you will need to give some blood through a finger prick. Doctors are looking for two kinds of antibodies to fight SARS-COV-2. These are:

  1. IgM antibodies – these occur early on in an infection
  2. IgG antibodies – these most likely occur later on after you have completely recovered

How is an Antibody Test different from a Coronavirus Test?

A coronavirus test, which is also sometimes called the diagnostic test, is done to look for signs of active virus. It’s both easier as well as faster compared to the antibody test. However, it only goes on to show whether or not you have this virus in your body at the moment you are being tested.

On the other hand, an antibody test is done to see whether you had this virus at some point of time in the past; you could still be infected, or be completely cured.

How Does Medical Billing Come Into Picture?

The AMA (American Medical Association) announced two new CPT codes for antibody serology tests (i.e. blood tests), specific to SARS-CoV-2, effective 2nd April 2020. All the medical billing systems were thus updated with the CMS pricing, not long after the pricing was released.

The following are the codes that are to be used when testing for Coronavirus-specific Antibodies:

Code 86328

By Code 86328, the AMA refers to a simple one-step test that’s often used as a point-of-care test which could be done at a physician’s office. As per AMA’s direction, if two distinct antibodies are tested, then only one unit is billable.

Code 86769

By Code 86769, the AMA refers to a test consisting of multiple steps that’s likely to be done by either a hospital or an independent lab. As per AMA’s direction, if two distinct antibodies are tested, then two units are billable.

Finally,

The antibody tests must have FDA approval and the office that performs such a test must have a CLIA (Clinical Laboratory Improvement Amendments) waiver certification in order to bill for these services.

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