Does 87913 require prior authorization?

No, 87913 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 87913?

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

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

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.

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 in the Part B outpatient setting when the panel contains five or fewer respiratory pathogens.
The outpatient location must be equipped to deliver timely reporting of test results to treating providers.

A58575 — Billing and Coding: Respiratory Pathogen Panel Testing

A58577 — Billing and Coding: Respiratory Pathogen Panel Testing

L38916 — Respiratory Pathogen Panel Testing

L38918 — Respiratory Pathogen Panel Testing

CIGNA-0557 — COVID-19: In Vitro Diagnostic Testing - (0557)

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