Billing and Coding Article

Billing and Coding: Influenza Diagnostic Tests

A54769

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Palmetto GBA	A and B MAC	10111 - MAC A	J - J	Alabama
Palmetto GBA	A and B MAC	10112 - MAC B	J - J	Alabama
Palmetto GBA	A and B MAC	10211 - MAC A	J - J	Georgia
Palmetto GBA	A and B MAC	10212 - MAC B	J - J	Georgia
Palmetto GBA	A and B MAC	10311 - MAC A	J - J	Tennessee
Palmetto GBA	A and B MAC	10312 - MAC B	J - J	Tennessee
Palmetto GBA	A and B and HHH MAC	11201 - MAC A	J - M	South Carolina
Palmetto GBA	A and B and HHH MAC	11202 - MAC B	J - M	South Carolina
Palmetto GBA	A and B and HHH MAC	11301 - MAC A	J - M	Virginia
Palmetto GBA	A and B and HHH MAC	11302 - MAC B	J - M	Virginia
Palmetto GBA	A and B and HHH MAC	11401 - MAC A	J - M	West Virginia
Palmetto GBA	A and B and HHH MAC	11402 - MAC B	J - M	West Virginia
Palmetto GBA	A and B and HHH MAC	11501 - MAC A	J - M	North Carolina
Palmetto GBA	A and B and HHH MAC	11502 - MAC B	J - M	North Carolina

Article Information

General Information

Article ID
A54769

Article Title
Billing and Coding: Influenza Diagnostic Tests

Article Type
Billing and Coding

Original Effective Date
12/10/2015

Revision Effective Date
01/01/2022

Revision Ending Date
N/A

Retirement Date
N/A

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CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA) §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim

Article Guidance

Article Text

To avoid the overuse of antibiotics and the potential risk of antibiotic resistance, point of care providers should consider testing patients prior to prescribing treatment for a bacterial or influenza infection. Influenza testing (using molecular methods) is recommended for hospitalized patients with suspected influenza. However, testing is not needed for all outpatients with signs and symptoms consistent with influenza before making antiviral treatment decisions, particularly once influenza activity has been documented in the community. The following summary provides a list of the main available types of diagnostics tests:

Rapid Antigen Tests:

Available at the point of care
Yields a Flu A and Flu B result in < 30 minutes
Less sensitive (50%-70%) and specific (90%-95%) compared to other methods and may require confirmation by reverse transcription-polymerase chain reaction (RT-PCR) or viral culture. Note: the Food and Drug Administration (FDA) now requires that all Rapid influenza diagnostic tests (RIDTs) achieve 80% or higher sensitivity compared with RT-PCR.
Centers for Disease Control and Prevention (CDC) recommendations:
- Use rapid diagnostic tests with high sensitivity and specificity.
- Collect respiratory tract specimens as early in the illness as possible (within 3-4 days of illness onset).
- Follow manufacturer’s instructions, including handling of respiratory specimens, as described in the device package insert.
- Consider sending respiratory specimens (from symptomatic patients) for RT-PCR to confirm results of RIDTs, especially in the following situations:
  - When community influenza activity is low and the rapid diagnostic test result is positive.
  - When community influenza activity is high and the rapid diagnostic test result is negative.

Contact your local or state health department for information about influenza activity.

- - A patient has had recent close exposure (this does NOT include eating cooked meat) to pigs or birds (including poultry) or other animals, and there is concern for infection with a novel influenza A virus.

Targeted Molecular Methods:

Uses RT-PCR or other amplification methods to detect viral nucleic acids
Results available in < 24 hours (often in less than 2-4 hours)
Detects from 1-2 to up to 20 respiratory pathogens from 1 specimen
A positive result (on testing of an upper respiratory tract specimen) in a person who recently received intranasal administration of live attenuated influenza virus vaccine (LAIV) may indicate detection of vaccine virus.

Viral Culture:

Confirms present active infection
Results available in 3-10 days
Misses opportunity for Oseltamivir (Tamiflu) treatment for positive patients

Immunofluorescence (IF) - Direct (DFA) or Indirect (IFA) Fluorescent Antibody Staining (antigen detection):

Moderate sensitivity and high specificity
Results available in approximately 2-4 hours

If a rapid antigen test is performed and then confirmed using PCR, the second test may require the -59 modifier.

If a CLIA-waived test is performed, the -QW modifier should be reported for the waived test.

Reference: Centers for Disease Control and Prevention. Information for Clinicians on Rapid Diagnostic Testing for Influenza. Accessed 4/27/21.

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1

(2 Codes)

Group 1 Paragraph

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Group 1 Codes

Code	Description
59	DISTINCT PROCEDURAL SERVICE: UNDER CERTAIN CIRCUMSTANCES, THE PHYSICIAN MAY NEED TO INDICATE THAT A PROCEDURE OR SERVICE WAS DISTINCT OR INDEPENDENT FROM OTHER SERVICES PERFORMED ON THE SAME DAY. MODIFIER -59 IS USED TO IDENTIFY PROCEDURES/SERVICES THAT ARE NOT NORMALLY REPORTED TOGETHER, BUT ARE APPROPRIATE UNDER THE CIRCUMSTANCES. THIS MAY REPRESENT A DIFFERENT SESSION OR PATIENT ENCOUNTER, DIFFERENT PROCEDURE OR SURGERY, DIFFERNET SITE OR ORGAN SYSTEM, SEPARATE INCISION/EXCISION, SEPARATE LESION, OR SEPARATE INJURY (OR AREA OF INJURY IN EXTENSIVE INJURIES) NOT ORDINARILY ENCOUNTERED OR PERFORMED ON THE SAME DAY BY THE SAME PHYSICIAN. HOWEVER, WHAN ANOTHER ALREADY ESTABLISHED MODIFIER IS APPROPRIATE IT SHOULD BE USED RATHER THAN MODIFIER -59. ONLY IF NO MORE DESCRIPTIVE MODIFIER IS AVAILABLE, AND THE USE OF MODIFIER -59 BEST EXPLAINS THE CIRCUMSTANCES, SHOULD MODIFIER -59 BE USED. MODIFIER CODE 09959 MAY BE USED AS AN ALTERNATE TO MODIFIER -59.
QW	CLIA WAIVED TEST

ICD-10-CM Codes that Support Medical Necessity

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ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code	Description
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code	Description
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Other Coding Information

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
01/01/2022	R8	Under *CPT/HCPCS Codes Group 1: Codes* the description was revised for 87400. This revision is due to the 2022 Annual CPT^®/HCPCS Code Update and is effective on 1/1/2022.
06/10/2021	R7	Under *CPT/HCPCS Codes Group 1: Codes* deleted 87631, 87636, 87637, 87807, 0202U, 0223U and 0225U. The addition of codes 87636, 87637, 0202U, 0223U and 0225U in revision #6 should be disregarded.
06/10/2021	R6	Under *CMS National Coverage Policy* added the regulation “Title XVIII of the Social Security Act (SSA) §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.” Under *Article Text* revised the first paragraph to state “To avoid the overuse of antibiotics and the potential risk of antibiotic resistance, point of care providers should consider testing patients prior to prescribing treatment for a bacterial or influenza infection. Influenza testing (using molecular methods) is recommended for hospitalized patients with suspected influenza. However, testing is not needed for all outpatients with signs and symptoms consistent with influenza before making antiviral treatment decisions, particularly once influenza activity has been documented in the community. The following summary provides a list of the main available types of diagnostics tests.” Under the subheading *Rapid Antigen Tests* deleted the verbiage “with another method” and added the verbiage “by reverse transcription-polymerase chain reaction (RT-PCR) or viral culture. Note: the Food and Drug Administration (FDA) now requires that all Rapid influenza diagnostic tests (RIDTs) achieve 80% or higher sensitivity compared with RT-PCR” to the end of the third bullet point. Deleted the fifth and sixth bullet point and added the verbiage: “Use rapid diagnostic tests with high sensitivity and specificity. Collect respiratory tract specimens as early in the illness as possible (within 3-4 days of illness onset). Follow manufacturer’s instructions, including handling of respiratory specimens, as described in the device package insert. Consider sending respiratory specimens (from symptomatic patients) for RT-PCR to confirm results of RIDTs, especially in the following situations: When community influenza activity is low and the rapid diagnostic test result is positive. When community influenza activity is high and the rapid diagnostic test result is negative. Contact your local or state health department for information about influenza activity. A patient has had recent close exposure (this does NOT include eating cooked meat) to pigs or birds (including poultry) or other animals, and there is concern for infection with a novel influenza A virus.” Under the subheading *Targeted Molecular Methods* deleted the word “isothermal” and replaced it with “other” in the first bullet point. Added the verbiage “(often in less than 2-4 hours)” to the second bullet point. Added the fourth bullet point verbiage “A positive result (on testing of an upper respiratory tract specimen) in a person who recently received intranasal administration of live attenuated influenza virus vaccine (LAIV) may indicate detection of vaccine virus.” Under the subheading *Viral Culture* added the word “Oseltamivir” to the third bullet point. Added the subheading *Immunofluorescence (IF) - Direct (DFA) or Indirect (IFA) Fluorescent Antibody Staining (antigen detection)* and the corresponding bullet points. Deleted the *CPT^® Coding Guidance for Diagnostic Tests* subheading and associated table. Updated the *Reference* to reflect AMA citation guidelines. Under *CPT/HCPCS Codes Group 1: Codes* added 87275, 87276, 87400, 87636, 87637, 0202U, 0223U, 0225U and deleted 87632 and 87633. Typographical errors were corrected throughout the article. Acronyms were inserted and defined where appropriate throughout the article. This revision will become effective 6/10/2021. Under *CPT/HCPCS Codes Group 1: Codes* the description was revised for 87804 and 87807. This revision is due to the Q2 2021 CPT/HCPCS Code Update and is effective for dates of service on or after 4/1/2021.
10/24/2019	R5	This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual. Under *Article Title* changed the title from “Influenza Diagnostic Tests” to “Billing and Coding: Influenza Diagnostic Tests”. Under Article Text subheading *Reference* the access date was updated for the CDC website. Under CPT/HCPCS Modifiers Group 1: Codes added modifiers 59 and QW. CPT^® was inserted throughout the article where applicable. Formatting and typographical errors were corrected throughout the article.
11/22/2018	R4	Removed "Test Selection" section from Article.
02/26/2018	R3	The Jurisdiction "J" Part A and Part B Contracts for Alabama (10111/10112), Georgia (10211/10212) and Tennessee (10311/10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these 6 contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 6 Part A and B contract numbers) have been completed in this revision.
11/23/2017	R2	Updated to correct table and bullet formatting
01/01/2017	R1	Under *CPT/HCPCS Codes* the description was revised for CPT code 87253. This revision is due to the 2017 Annual CPT/HCPCS Code Update and becomes effective 1/1/17.

Associated Documents

Updated On	Effective Dates	Status
01/18/2022	01/01/2022 - N/A	Currently in Effect	You are here
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Keywords

Influenza

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Billing and Coding: Influenza Diagnostic Tests

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