| |
 | * The following article was archived on 06/23/2010.
| |
| | |
|
Access to Rapid H1N1 (Swine-Origin) Influenza A (Flu) Laboratory Tests in the Hospital Outpatient Laboratory Setting
Posted: 05/11/2009 | |
| | |
| | |
 |  | |
| Due to the recent cases of H1N1 (swine-origin) influenza A (Flu), it may be necessary for members to receive a rapid Flu test in the hospital outpatient laboratory setting. As such, the Company has expanded access for Health Maintenance Organization (HMO) and HMO Point-of-Service (POS) members to receive rapid flu tests in the hospital outpatient laboratory setting as a STAT laboratory test.
Members of Preferred Provider Organization (PPO) products continue to have access to rapid influenza (Flu) tests for H1N1 (swine-origin) influenza A in the hospital outpatient laboratory setting.
Effective April 27, 2009, when an HMO, HMO POS, or PPO member has symptoms of or has had exposure to H1N1 (swine-origin) influenza A (Flu), a rapid Flu laboratory test performed in the hospital outpatient laboratory setting is eligible for coverage and reimbursement consideration as a STAT laboratory test.
Precertification and referrals are not required for a rapid Flu STAT laboratory test for H1N1 (swine-origin) influenza A (Flu) for HMO and HMO POS members. However:
- These tests may be performed by any participating hospital laboratory only when a participating provider (ie, the individual's primary care physician [PCP] or specialist) requests the STAT laboratory test via a written order.
- These tests must be reported using one of the procedure codes listed below.
To report a rapid H1N1 (swine-origin) influenza A (Flu) laboratory test, use the following CPT codes:
- 87400: Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Influenza, A or B, each
- 87804: Infectious agent antigen detection by immunoassay with direct optical observation; Influenza
If you have any questions, contact your Network Coordinator.
Related Policy:
00.01.41, STAT Laboratory Tests Performed in the Outpatient Hospital Setting for Health Maintenance Organization (HMO) and Point of Service (POS) Products
| |
|