IHCP to Allow CLIA Certificate of Waiver for CPT Code 87636

Effective immediately, the CoreMMIS claim-processing system has been updated for Current Procedural Terminology (CPT®1) code 87636 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique.

Procedure code 87636 was considered a CLIA-waived test as of October 6, 2020. Claims for code 87636 with dates of service (DOS) on or after October 6, 2020, will be billable by laboratories that have a valid CLIA certificate of waiver. The FFS claim-processing system has been updated to classify CPT code 87636 as a CLIA-waived test. This change applies retroactively to claims with DOS on or after October 6, 2020.

Providers with valid CLIA certificates of waiver that submitted claims or claim details for code 87636 that denied for explanation of benefits (EOB) 4208 – The procedure code billed is invalid with your CLIA certification on file during the indicated time frame will be mass reprocessed or mass adjusted, as appropriate. Providers should see reprocessed or adjusted claims on Remittance Advices (RAs) beginning June 16, 2021, with internal control numbers (ICNs)/Claim IDs that begin with 80 (reprocessed denied claims) or 52 (mass replacements non-check related).