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CPT 87426: SARS–CoV–2 Antigen Immunoassay, Blood
CPT code 87426 denotes a laboratory immunoassay to qualitatively or semiquantitatively detect SARS–CoV–2 antigens in a patient blood specimen. This code is used for antigen-based testing that identifies active coronavirus infection through detection of viral proteins rather than nucleic acid. Nationally, antigen testing remains an important diagnostic tool for rapid identification of COVID–19 cases in clinical and public health settings.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication outlines payer coverage context, common clinical uses, and how 87426 compares to related SARS–CoV–2 laboratory codes for molecular testing and antibody assays.
Readers will learn the clinical scope of 87426, typical sites of service where the test is performed, and how it fits alongside related diagnostic codes such as nucleic acid detection and antibody testing. The summary provides benchmarks and policy-relevant points to inform billing, coding, and operational decisions for laboratories and clinicians performing SARS–CoV–2 antigen immunoassays. Data not available in the input where applicable will be noted in detailed sections.
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Billing Code Overview
CPT code 87426 describes an immunoassay performed by a laboratory analyst to qualitatively or semiquantitatively detect antigens of severe acute respiratory syndrome coronavirus (SARS–CoV–2) in a patient blood specimen. The procedure identifies viral antigens associated with coronavirus disease 2019 (COVID–19) and is used to determine current infection status based on antigen presence.
Service Type: Clinical laboratory infectious agent antigen detection by immunoassay.
Typical Site of Service: Clinical laboratory or hospital laboratory setting; specimen collection commonly occurs in outpatient clinics, testing centers, or hospital phlebotomy units.
National Reimbursement Benchmarks
National commercial rates for CPT 87426 center on BUCA’s mean of $38.70 as the average commercial benchmark, with individual payer medians and means showing meaningful variation. Blue Cross Blue Shield’s interquartile spread (P75–P25) is $13.00, Cigna’s spread is $24.40, Aetna’s spread is $11.10, and UnitedHealth Group’s spread is $22.60, indicating that Blue Cross Blue Shield and Aetna have the tightest middle-range dispersions while Cigna and UnitedHealth Group exhibit wider volatility in the middle 50% of rates.
Looking at extremes and central tendency, Aetna and UnitedHealth Group show the largest upper-end maximums at $114.80 and $140.00 respectively, while Cigna and Aetna include the lowest observed minimums at $5.20 and $9.10. BUCA’s mean of $38.70 sits near the midpoint of payer means, underscoring that average commercial reimbursement falls in the high $30s despite notable payer-specific spread differences.