86413
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Documentation that the antibody test used has received FDA EUA.
- Reference or availability of the test's instructions for use (IFU) showing individual performance characteristics.
- Document review of the member's benefit contract or Summary Plan Description (SPD) to determine coverage vs. non-coverage, exclusions, and limits.
- Document the written Medical Policy coverage position used to support coverage or denial decisions.
Key Coverage Criteria
- Infection with human coronavirus 229E (alpha coronavirus).
- Infection with human coronavirus NL63 (alpha coronavirus).
- Infection with human coronavirus OC43 (beta coronavirus).
- Infection with human coronavirus HKU1 (beta coronavirus).
- Infection with MERS‑CoV (beta coronavirus that causes Middle East Respiratory Syndrome, MERS).
- Infection with SARS‑CoV (beta coronavirus that causes severe acute respiratory syndrome, SARS).
6 Active Policies
BCBSIL-MED207.162 — SARS-CoV-2 (COVID-19) Antibody Testing
BCBSMT-MED207.162 — SARS-CoV-2 (COVID-19) Antibody Testing
BCBSNM-MED207.162 — SARS-CoV-2 (COVID-19) Antibody Testing
BCBSOK-MED207.162 — SARS-CoV-2 (COVID-19) Antibody Testing
REGENCE-LAB74 — COVID-19 Testing
Related Codes
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