Billing and Coding: Influenza Diagnostic Tests

Molecular testing (eg, RT-PCR) is recommended for hospitalized patients with suspected influenza and for confirmation of rapid test results in specific situations (low community activity with positive RIDT, high community activity with negative RIDT, or suspected novel influenza A after animal exposure). Choose RIDTs that meet FDA sensitivity standards (≥80% vs RT-PCR), collect respiratory specimens within 3–4 days of symptom onset, follow manufacturer instructions, and apply billing modifiers (-59 for confirmatory PCR and -QW for CLIA-waived tests) as required.

"Perform molecular influenza testing (eg, RT-PCR) for hospitalized patients with suspected influenza."

Sign up to see full coverage criteria, indications, and limitations.