Does 87501 require prior authorization?

No, 87501 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 87501?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Follow the device manufacturer’s package insert for specimen collection, handling, and test performance as required for test validity and billing.
Document timing of symptom onset and specimen collection (ideally within 3–4 days of onset) in the medical record.
When a rapid antigen test is performed and then confirmed using PCR, report the confirmatory test with modifier -59 as appropriate for billing.
When a CLIA-waived test is performed, report the waived test with the -QW modifier for billing.

Perform molecular influenza testing (eg, RT-PCR) for hospitalized patients with suspected influenza.
Point-of-care providers should consider influenza testing prior to prescribing antibiotics or antiviral treatment when needed to avoid antibiotic overuse and resistance.
Use rapid influenza diagnostic tests (RIDTs) that meet FDA sensitivity expectations (≥80% vs RT-PCR) and have high specificity when selecting a rapid diagnostic test.
Collect respiratory tract specimens for influenza testing as early in illness as possible, preferably within 3–4 days of symptom onset.
Consider targeted molecular methods (eg, multiplex RT-PCR) to detect influenza and other respiratory pathogens from a single specimen when broader pathogen detection is clinically useful.
Send respiratory specimens for RT-PCR to confirm RIDT results when community influenza activity is low and RIDT is positive.

L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

A58710 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58720 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

Ask Verity about documentation requirements, denial risks, or coverage in your state.