Show State Reimbursement for:
| Direct Specimen DFA | |||||
| CPT1 | Modifier(s)2,3 | Descriptor(s) | Unit(s) Per Results Reported |
CMS Limits | |
| Nat'l4 | State4 | ||||
| 87280 | RSV direct specimen; detection with immunofluorescence [ Show Long Descriptor ] |
1 | $16.49 | n/a | |
| 87300 | Multiple organism pool (respiratory virus screen) direct specimen; detection with immunofluorescence [ Show Long Descriptor ] |
1 | $16.49 | n/a | |
| 87276 | Influenza A direct specimen; detection with immunofluorescence [ Show Long Descriptor ] |
1 | $16.49 | n/a | |
| 87275 | Influenza B direct specimen; detection with immunofluorescence [ Show Long Descriptor ] |
1 | $16.49 | n/a | |
| 87260 | Adenovirus direct specimen; detection with immunofluorescence [ Show Long Descriptor ] |
1 | $16.49 | n/a | |
| 87279 | Parainfluenza direct specimen; detection with immunofluorescence, each type [ Show Long Descriptor ] |
1 | $16.49 | n/a | |
| 87279 | 59 | Parainfluenza direct specimen; detection with immunofluorescence, each type [ Show Long Descriptor ] |
2 | $16.49 | n/a |
| Cell Culture - Shell Vial or Multi-Well Plate5 | |||||
| CPT1 | Modifier(s)2,3 | Descriptor(s) | Unit(s) Per Results Reported |
CMS Limits | |
| Nat'l4 | State4 | ||||
| 87254 | Shell vial or multi-well plate culture with immunofluorescence, first reported result [ Show Long Descriptor ] |
1 | $26.88 | n/a | |
| 87254 | 59 | Shell vial or multi-well plate culture with immunofluorescence, each subsequent result [ Show Long Descriptor ] |
6 | $26.88 | n/a |
Important Notes:
1 CPT is a registered trademark of the American Medical Association. https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp
2 QW modifier is added to report use of CLIA-waived test system(s) for Medicare and Medicaid claims
3 59 modifier is used to report procedures that are distinct or independent, such as performing the same procedure (that uses the same procedure code) for testing of a different specimen or different strain. Use modifier 59 when separate results are reported for different species or strains described by the same CPT code (AMA CPT Assistant, May 2009 Vol 19 Issue 5). Alternatively, it is possible that when reporting multiple results using the same CPT code, some payers may not require use of a modifier and/or may require use of the units of service box on the claim form.
4 Medicare Clinical Laboratory Fee Schedule, http://www.cms.gov/ClinicalLabFeeSched/02_clinlab.asp
Under Federal and State law, it is the individual provider's responsibility to determine appropriate coding, charges and claims for a particular service. Policies regarding appropriate coding and payment levels can vary greatly from payer to payer and change over time. Quidel Corporation strongly recommends that providers contact their contracted payers to determine appropriate coding and charge or payment levels prior to submitting claims.