The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association have released a CPT code for an antigen test designed to detect proteins from the virus that causes COVID-19 in respiratory specimens.
NC Medicaid is adding the following code into NCTracks for medically necessary laboratory testing effective Sept. 1, 2020, as follows:
CPT 87426-Infectious agent antigen detection by immunoassay technique (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).
NC Medicaid notes that antigen tests are generally less sensitive than PCR-based methods and their clinical performance depends on the circumstances in which they are used. Due to the lower sensitivity, antigen testing is best when there is a high pre-test probability of SARS-CoV-2 infection (e.g., high prevalence of infection in the community, clinical context and symptoms of the recipient of the test).
Example populations or circumstances in which antigen testing could be considered:
- Symptomatic individuals in whom COVID-19 is suspected, particularly within 5-7 days of symptom onset. Note that two of the four antigen tests with FDA EUA are approved for use within 5 days, one within 7 days, and one within 12 days of symptom onset.
- Symptomatic and asymptomatic individuals in congregate settings, like nursing homes or similar settings, where less frequent, highly sensitive tests are not available or subject to prolonged turnaround times and in accordance with federal guidance.
Evaluating Antigen Testing Results
Positive antigen tests should be considered an indication of likely SARS-CoV-2 infection, especially when pretest probability is high.
Negative antigen test results should be considered in the context of a patient’s recent exposures, history and the presence of clinical signs and symptoms consistent with COVID-19, and confirmed with an FDA-authorized molecular assay, if necessary, for patient management. Specific considerations for interpreting antigen results in nursing homes have been posted by the CDC.
Reporting Antigen Test Results
All positive and negative antigen results must be reported as part of required reporting of COVID-19 diagnostic tests. The requirements and methods of reporting for antigen tests are the same as for molecular PCR tests.
Laboratories are required to report electronically, either via Electronic Lab Reporting (ELR) or in accordance with the laboratory data automation process outlined in the guidance for reporting results.
Physicians and other health care providers are required to report all positive and negative test results that will not be reported by a laboratory in accordance with this guidance within 24 hours of receiving the test result to the local health director in the county or district where the patient resides. The State is developing an online survey where providers can report the aggregate number of positive and negative nucleic acid COVID-19 diagnostic tests and the aggregate number of positive and negative antigen COVID-19 diagnostic tests per day to the Division of Public Health.
Physicians are required to report accompanying data for all positive tests by telephone or secure fax to the local health director in the county or district where the patient resides, even if the result is reported by a laboratory in accordance with this guidance.
Additional guidance can be found here: Our guidance.
NCTracks Contact Center: 800-688-6696