87428
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
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the medical record must be legible and include appropriate patient identification (e.g., complete name, dates of service).
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Key Coverage Criteria
- Respiratory pathogen panel testing is covered when performed in an outpatient, non-institutional Part B setting from a single biologic specimen on a single date of service and the order is not a reflex test.
- Respiratory pathogen panel testing is covered when the medical record documents that the testing facility can deliver timely results and that the test results can reasonably be expected to change clinical management and improve patient health outcomes.
- Respiratory pathogen panel testing is covered when performed as a single service from a single biologic specimen in the outpatient setting on a single date of service and is reasonable and necessary per LCD L38918.
- The test is covered when performed in a Medicare Part B setting that is equipped to deliver timely results and when the results can reasonably be expected to lead to a change in clinical management that improves health outcomes.
- Respiratory pathogen panel testing is covered when performed in an outpatient Medicare Part B setting using a single biologic specimen collected and tested on a single date of service, and the results are timely and can affect clinical management to improve patient health outcomes.
- A panel is defined as all respiratory pathogens tested on that single specimen/date and is covered when ordered as a panel (not as a reflex test).
10 Active Policies
FIRST_COAST-L38918 — Respiratory Pathogen Panel Testing
J9 MAC Part B
NGS-L39027 — Respiratory Pathogen Panel Testing
JK MAC Part B
NOVITAS-L38916 — Respiratory Pathogen Panel Testing
JL MAC Part B
L39027 — Respiratory Pathogen Panel Testing
L38916 — Respiratory Pathogen Panel Testing
Related Codes
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