2025 CPT code 87426
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Microbiology Procedures Pathology and Laboratory Procedures Feed
Infectious agent antigen detection by immunoassay; severe acute respiratory syndrome coronavirus (SARS-CoV, SARS-CoV-2 [COVID-19]).
Modifiers such as 90 (reference laboratory) or 91 (repeat test) may apply depending on the specific circumstances.
Medical necessity for this test is established when the physician orders it to diagnose or rule out COVID-19 infection, for pre-operative screening in high-risk situations, or for monitoring healthcare workers with potential exposure.
The clinical responsibility lies with the laboratory analyst who performs the immunoassay, interprets the results, and reports them to the ordering physician. The ordering physician is responsible for integrating the results into the patient's overall care.
In simple words: This lab test checks a blood sample for the presence of the virus that causes COVID-19.The test uses a special method to detect parts of the virus.
This CPT code represents the qualitative or semiquantitative detection of severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-2, which causes COVID-19) antigens in a patient specimen using an immunoassay technique.Immunoassay techniques may include enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay (FIA), or immunochemiluminometric assay (IMCA). The test evaluates the presence and/or concentration of the viral antigen.
Example 1: A patient presents with symptoms consistent with COVID-19 (fever, cough, shortness of breath).The physician orders this test to confirm the diagnosis., A patient requires pre-operative testing before a scheduled surgery.The physician orders this test as part of routine pre-operative screening., A healthcare worker is exposed to a patient with confirmed COVID-19.This test is ordered to monitor for infection.
Complete patient demographics, date of service, specimen type (e.g., nasal swab, blood), test result (qualitative or semi-quantitative), and physician's order.
** This code may be used in conjunction with other codes for complete billing.Payers may have specific requirements for reimbursement.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: The relative value units (RVUs) for this code vary depending on the payer and geographic location.Consult the specific payer's fee schedule for the most current information.RVUs are used to calculate reimbursement rates.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier is not applicable to this code, as the entire service is considered a professional component.
- Fee Schedule: Historical fee schedule information is available from various payers and may vary depending on the year, location, and payer.
- Specialties:Infectious Disease, Internal Medicine, Emergency Medicine, Pathology
- Place of Service:Office, Hospital, Laboratory, Urgent Care Facility, Other Place of Service