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

CMS requires use of the new 2018 CPT codes for Zika testing for dates of service on/after 1/1/2018 (use prior-code instructions for earlier dates—e.g., CPT 87999 with narrative "Zika PCR" or "Zika Trioplex", 86790 for anti‑Zika IgM, 87798/87801 for dengue/chikungunya), while confirmatory PRNT testing must be performed only by CDC or CDC‑designated labs and is not billed to Medicare. Key requirements: testing must follow FDA and CDC guidance, labs must have an applicable Emergency Use Authorization (EUA) (Noridian may request EUA documentation), and claim submissions must include the specified narrative verbiage in the claim form.

"In the narrative section of the claim form (Part A Loop 2300/NTE for EMC claims, or Form Locator 80 on the CMS 1450 form or paper claims, Part B Loop 2400/SV101-7 for EMC claims, or Item 19 on the ..."

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