PDF Version
TO: Physicians, Independent Labs,
Hospitals and Other Lab Providers
RE: Respiratory Pathogen Panel
Tests (CPT 87631 – 87633) Coverage Update
A panel test is a single test with multiple components. Effective on or
after August 1, 2025, the following changes will take effect:
CPT 87631-87633 may only be billed as one unit per date of service
CPT
87632 and 87633 may only be filed on outpatient (UB-04) claims for place of
service (POS) 19, 21, 22, and 23:
|
POS Code
|
POS Code Description
|
|
19
|
OFF CAMPUS -
OUTPATIENT HOSPTIAL
|
|
21
|
INPATIENT HOSPITAL
|
|
22
|
ON CAMPUS -
OUTPATIENT HOSPITAL
|
|
23
|
EMERGENCY ROOM
|
The following list of
codes may not be billed with CPT 87154, 87505-87507, 87631-87633, 87636, 87637,
87800, 87801:
|
CPT Code
|
CPT Description
|
|
CPT Code
|
CPT Description
|
|
87149
|
DNA/RNA DIRECT
PROBE
|
|
87534
|
HIV-1 DNA DIR
PROBE
|
|
87150
|
DNA/RNA AMPLIFIED
PROBE
|
|
87535
|
HIV-1
PROBE&REVERSE TRNSCRPJ
|
|
87471
|
BARTONELLA DNA AMP
PROBE
|
|
87536
|
HIV-1
QUANT&REVRSE TRNSCRPJ
|
|
87475
|
LYME DIS DNA DIR
PROBE
|
|
87537
|
HIV-2 DNA DIR
PROBE
|
|
87476
|
LYME DIS DNA AMP
PROBE
|
|
87538
|
HIV-2
PROBE&REVRSE TRNSCRIPJ
|
|
87480
|
CANDIDA DNA DIR
PROBE
|
|
87539
|
HIV-2
QUANT&REVRSE TRNSCRIPJ
|
|
87481
|
CANDIDA DNA AMP
PROBE
|
|
87540
|
LEGION PNEUMO DNA DIR
PROB
|
|
87482
|
CANDIDA DNA
QUANT
|
|
87541
|
LEGION PNEUMO DNA AMP
PROB
|
|
87485
|
CHLMYD PNEUM DNA DIR
PROBE
|
|
87550
|
MYCOBACTERIA DNA DIR
PROBE
|
|
87486
|
CHLMYD PNEUM DNA AMP
PROBE
|
|
87551
|
MYCOBACTERIA DNA AMP
PROBE
|
|
87490
|
CHLMYD TRACH DNA DIR
PROBE
|
|
87555
|
M.TUBERCULO DNA DIR
PROBE
|
|
87491
|
CHLMYD TRACH DNA AMP
PROBE
|
|
87556
|
M.TUBERCULO DNA AMP
PROBE
|
|
87493
|
C DIFF AMPLIFIED
PROBE
|
|
87560
|
M.AVIUM-INTRA DNA DIR
PROB
|
|
87495
|
CYTOMEG DNA DIR
PROBE
|
|
87561
|
M.AVIUM-INTRA DNA AMP
PROB
|
|
87496
|
CYTOMEG DNA AMP
PROBE
|
|
87580
|
M.PNEUMON DNA DIR
PROBE
|
|
87497
|
CYTOMEG DNA
QUANT
|
|
87581
|
M.PNEUMON DNA AMP
PROBE
|
|
87498
|
ENTEROVIRUS
PROBE&REVRS TRNS
|
|
87590
|
N.GONORRHOEAE DNA DIR
PROB
|
|
87501
|
INFLUENZA DNA AMP
PROB 1+
|
|
87591
|
N.GONORRHOEAE DNA AMP
PROB
|
|
87502
|
INFLUENZA DNA AMP
PROBE
|
|
87592
|
N.GONORRHOEAE DNA
QUANT
|
|
87503
|
INFLUENZA DNA AMP
PROB ADDL
|
|
87623
|
HPV LOW-RISK
TYPES
|
|
87510
|
GARDNER VAG DNA DIR
PROBE
|
|
87624
|
HPV HIGH-RISK
TYPES
|
|
87511
|
GARDNER VAG DNA AMP
PROBE
|
|
87625
|
HPV TYPES 16 & 18
ONLY
|
|
87512
|
GARDNER VAG DNA
QUANT
|
|
87634
|
RSV DNA/RNA AMP
PROBE
|
|
87516
|
HEPATITIS B DNA AMP
PROBE
|
|
87635
|
SARS-COV-2 COVID-19
AMP PRB
|
|
87517
|
HEPATITIS B DNA
QUANT
|
|
87640
|
STAPH A DNA AMP
PROBE
|
|
87520
|
HEPATITIS C RNA DIR
PROBE
|
|
87641
|
MR-STAPH DNA AMP
PROBE
|
|
87521
|
HEPATITIS C
PROBE&RVRS TRNSC
|
|
87650
|
STREP A DNA DIR
PROBE
|
|
87522
|
HEPATITIS C REVRS
TRNSCRPJ
|
|
87651
|
STREP A DNA AMP
PROBE
|
|
87525
|
HEPATITIS G DNA DIR
PROBE
|
|
87653
|
STREP B DNA AMP
PROBE
|
|
87526
|
HEPATITIS G DNA AMP
PROBE
|
|
87660
|
TRICHOMONAS VAGIN DIR
PROBE
|
|
87528
|
HSV DNA DIR
PROBE
|
|
87661
|
TRICHOMONAS VAGINALIS
AMPLIF
|
|
87529
|
HSV DNA AMP
PROBE
|
|
87797
|
DETECT AGENT NOS DNA
DIR
|
|
87530
|
HSV DNA QUANT
|
|
87798
|
DETECT AGENT NOS DNA
AMP
|
|
87531
|
HHV-6 DNA DIR
PROBE
|
|
U0001
|
2019-NCOV DIAGNOSTIC
P
|
|
87532
|
HHV-6 DNA AMP
PROBE
|
|
U0002
|
COVID-19 LAB TEST
NON-CDC
|
|
87533
|
HHV-6 DNA QUANT
|
|
|
|
Medical
record documentation must support the use of any submitted CPT codes on a claim.
Providers
with policy questions may contact Medical Services at medicalservices@medicaid.alabama.gov.
Providers
with billing questions should contact the Gainwell Technology Provider
Assistance Center at
1-800-688-7989.
The Current Procedural Terminology (CPT) and Current
Dental Terminology (CDT) codes descriptors, and other data are copyright © 2025 American Medical Association
and © 2025 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.