New COVID-19 Testing Codes 87636, 87637 and 87811 Are Medi-Cal Benefits

Effective for dates of service on or after October 6, 2020, new CPT^® codes 87636, 87637 and 87811 are Medi-Cal benefits. All three codes do not have any gender or age restrictions, have a frequency limit of one each per day, any provider, per patient, and may be billed with any valid ICD-10-CM codes.

Two of the newly approved codes, 87636 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)] and influenza virus types A and B, multiplex amplified probe technique) and 87637 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)], influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique), allow a single test to simultaneously detect the novel coronavirus, and a combination of common viral infectious agents, including influenza A/B and respiratory syncytial virus.

Also approved is a new category I CPT code 87811 (infectious agent antigen detection by immunoassay with direct optical [ie visual] observation; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)]).

An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. The updated manual pages reflecting this change will be released in a future Medi-Cal Update.

Effective for dates of service on or after October 6, 2020, the rates for CPT^® codes 87636 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)] and influenza virus types A and B, multiplex amplified probe technique), 87637 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)], influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique) and 87811 (infectious agent antigen detection by immunoassay with direct optical [ie, visual] observation; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)]) are updated.

https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30717_07.aspx