Summary & Overview
CPT 87428: Antigen Detection for COVID-19 and Influenza A/B
CPT code 87428 is a critical laboratory procedure for the simultaneous detection of antigens from both SARS-CoV-2 (COVID-19) and influenza virus types A and B. This code covers immunoassay-based testing methods, which are widely used in clinical laboratories and office settings to quickly identify respiratory infections. The ability to test for multiple pathogens in a single assay is especially important during periods of high respiratory illness activity, such as flu season or COVID-19 surges, enabling timely diagnosis and management.
Major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare recognize and reimburse for this code, reflecting its broad clinical relevance and adoption. The publication provides an overview of payer coverage, clinical context, and policy updates related to 87428. Readers will gain insight into current benchmarks for laboratory testing, recent changes in reimbursement policies, and the role of this code in the broader landscape of infectious disease diagnostics. The summary also highlights the typical sites of service and the importance of accurate coding for laboratory procedures.
This article is designed for healthcare professionals, laboratory managers, and policy analysts seeking a comprehensive understanding of 87428 and its impact on clinical practice and billing.
CPT Code Overview
CPT code 87428 is used to report the detection of infectious agent antigens for both severe acute respiratory syndrome coronavirus (such as SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B. This test utilizes immunoassay techniques, including enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay (FIA), or immunochemiluminometric assay (IMCA), to provide qualitative or semiquantitative results.
Service Type: Pathology and Laboratory Procedures – Microbiology Procedures
Typical Site of Service: Laboratory setting (POS 81) or Office (POS 11)
Clinical & Coding Specifications
Clinical Context
A patient presents to a healthcare provider with symptoms of acute respiratory illness, such as fever, cough, and shortness of breath. The provider suspects infection with either severe acute respiratory syndrome coronavirus (SARS-CoV, SARS-CoV-2 {COVID-19}) or influenza virus types A or B. A specimen, typically a nasopharyngeal swab, is collected in the office or sent to a laboratory. The laboratory performs an immunoassay test using CPT code 87428 to qualitatively or semi-quantitatively detect antigens for both SARS-CoV-2 and influenza A/B. The results assist the provider in determining the cause of the patient's symptoms and guide further management.
Coding Specifications
- Modifier
QW: Indicates that the test is CLIA-waived and can be performed in settings with a CLIA Certificate of Waiver, such as physician offices or certain laboratories.
| Modifier Code | Description |
|---|---|
QW | CLIA waived test |
- Provider Taxonomies: