2025 CPT code 87811
(Active) Effective Date: N/A Pathology and Laboratory - Microbiology Feed
Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])
Modifiers 59, 76, 90, 91, 92, and other relevant modifiers may be applicable.
Medical necessity for this test is established by the patient's signs and symptoms suggestive of COVID-19, potential exposure to the virus, or requirements for specific activities (e.g., travel, work, or school).
The lab analyst performs all technical steps to analyze for the presence of SARS-CoV-2 in a specimen by immunoassay, which is an antibody–antigen reaction, and by direct optical observation.
In simple words: This test helps determine if you have COVID-19. A swab is taken from your nose and mixed with a special liquid.This mixture is then put on a test card or device. If the card changes color or a line appears, it likely means you have the virus.
This code describes a laboratory test for detecting the presence of SARS-CoV-2 (the virus causing COVID-19) in a patient specimen. The test uses an immunoassay method, which involves the reaction between an antibody and an antigen, and the results are determined by direct visual observation. A nasopharyngeal swab is typically collected from the patient and mixed with a reagent containing an antibody specific to SARS-CoV-2 antigens. This mixture is then applied to a card or device that produces a visual result, such as a color change or a line, indicating the presence or absence of the virus.
Example 1: A patient presents with fever, cough, and shortness of breath. A nasopharyngeal swab is collected and tested using the direct optical immunoassay method for SARS-CoV-2 to determine if the patient has COVID-19., An individual requires COVID-19 testing for travel or work-related purposes. A direct antigen test with visual observation is performed to provide rapid results., A healthcare worker experiences potential exposure to COVID-19. A rapid antigen test using direct optical observation is conducted for quick screening and infection control measures.
Documentation should include the reason for testing, the type of specimen collected (e.g., nasopharyngeal swab), the date and time of collection, the test method used (direct optical immunoassay), and the test result.
** CPT code 87811 is specific to antigen detection by direct optical observation and is distinct from molecular diagnostic tests.It is often used for rapid point-of-care testing.
- Revenue Code: T1H - LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE)
- Payment Status: Active
- Specialties:Clinical Laboratory, Infectious Disease, Internal Medicine, Family Medicine
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Clinic, Public Health Clinic, Mobile Unit, and other relevant places of service.