Laboratory Diagnostic Testing of Influenza
Humana Medicare Advantage payment policy describing reimbursement rules for laboratory diagnostic tests for influenza and which tests/diagnoses are reimbursable or not for Medicare Advantage members.
No material clinical or coverage changes in this revision.
Influenza Testing Reimbursement Criteria
Influenza testing reimbursement criteria
Reimbursement and exclusion criteria for specified influenza laboratory tests.
ALL of the following
- Test is one of the following CPT codes: 87804, 87400, 87501, 87502, 87275, 87276CPT codes list
- Patient presents with ONE OR MORE of the listed symptoms or diagnoses (examples include: abdominal pain; acute bronchitis; acute sinusitis; acute tonsillitis, laryngitis and tracheitis; asthma exacerbation; chest pain; cough; dehydration; fatigue; fever; gastritis, unspecified, without bleeding; headache; infectious mononucleosis; influenza; nausea, vomiting; pharyngitis; shortness of breath; upper respiratory infection; viral infections; viral intestinal infection, unspecified; viral or bacterial pneumonia; whooping cough).
At least one listed presenting symptom/diagnosis is required for reimbursement
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