Summary & Overview
CPT 87812: SARS–CoV–2 and Influenza A/B Antigen Immunoassay, Visual
CPT code 87812 represents a direct optical (visual) immunoassay that detects antigens for SARS–CoV–2 and influenza A and B from patient specimens, commonly nasal or throat swabs. This combined antigen test code matters nationally because it supports rapid respiratory virus detection at the point of care and in labs, informing clinical decision-making, infection control, and public health surveillance during respiratory virus seasons and outbreaks.
Key payers in the scope of standard coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of what the code represents, typical settings of service, and the clinical context for use. The publication also outlines expected benchmarks and policy-relevant topics readers can expect to see: utilization patterns for combined SARS–CoV–2/influenza antigen testing, payer coverage considerations, coding and billing implications for mixed respiratory panels, and how this code relates to rapid diagnostic workflows.
This summary is intended to orient clinicians, billing professionals, and policy stakeholders to the purpose and common use cases for CPT code 87812, and to indicate the types of operational and policy details covered in the full publication. Data not available in the input will be identified in relevant sections.
Billing Code Overview
CPT code 87812 describes an immunoassay with direct optical (visual) observation to detect antigens for severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) and influenza virus types A and B from a patient specimen. The assay is typically performed by a laboratory analyst who inspects the test device visually to determine presence of viral antigens.
Service type: Point-of-care or laboratory antigen immunoassay for combined SARS–CoV–2 and influenza A/B detection
Typical site of service: Outpatient clinics, urgent care centers, emergency departments, and clinical laboratories
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A symptomatic adult presents to an urgent care clinic in mid-winter with acute onset fever, cough, nasal congestion, and sore throat. A nurse collects a bilateral anterior nasal swab and delivers the specimen to the clinic laboratory. A lab analyst performs an immunoassay with direct optical (visual) observation to detect antigens for SARS–CoV–2 and influenza A/B using a CLIA-waived or moderate complexity point-of-care platform. The test result is read visually within the manufacturer-specified time window and documented in the electronic health record. Positive results prompt infection control measures and clinical management; negative results in a high-risk or high-suspicion patient may lead to molecular testing or repeat testing per clinical protocols. Typical site of service: outpatient clinic, urgent care, emergency department, or physician office laboratory; specimen: nasal or throat swab; service type: point-of-care antigen immunoassay.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a qualifying E/M visit is provided on the same date as the test and documentation supports a distinct E/M service |
59 |