This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38916, Respiratory Pathogen Panel Testing. Please refer to the LCD for reasonable and necessary requirements.
Coding Guidance
Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.
A respiratory pathogen panel test is a single service with a single unit of service (UOS=1). A respiratory pathogen panel test must not be unbundled and billed as individual components regardless of the fact that the panel reports multiple individual pathogens and/or targets.
The term “panel” refers to all respiratory pathogens tested in the outpatient setting on a single date of service from a single biologic specimen, not ordered as a reflex test.
Please note: The services addressed in this article and related LCD are not applicable to providers submitting claims on institutional claim forms.
Documentation Requirements
- All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
- The medical record MUST support that the test was completed in a Part B setting that is equipped to deliver timely results AND for patients where the test demonstrates that clinical management can result in an improved health outcome.