Billing and Coding: Zika Virus Testing by PCR and ELISA Methods

This policy provides coding and billing instructions for Zika virus PCR and IgM testing: use pre-2018 CPT mapping (e.g., CPT 87999 with narrative 'Zika PCR') for dates of service before 1/1/2018 and the 2018 CPT codes (e.g., CPT 87662 for Zika rRT-PCR, CPT 86794 for Zika IgM) for dates of service on/after 1/1/2018. Claims must include at least one of the specified ICD-10 diagnosis codes, follow FDA and CDC testing guidelines, and laboratories performing EUA-required tests must have an FDA Emergency Use Authorization available upon request; PRNT confirmatory testing must be performed by CDC or CDC-designated labs and is not billed to Medicare.

"For dates of service on or after 1/1/2018, bill Zika rRT-PCR using CPT 87662 when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes and testing follows FDA..."

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