how to code 87804 icd 10 for bcbs

by Marielle Hoeger 10 min read

How do you Bill a test code 87804 twice?

If you use a product that distinguishes between influenza A &B and the doctor documents both results, you should code 87804 twice. Technically it’s two tests just done in one so you’re right in billing twice since the physician is documenting two results. If the test doesn’t differentiate, just a positive/negative then you’d bill the code once.

What is the CPT code for influenza A and B?

Use 87804 coding rule while testing for strains A & B When your office makes use of an A&B influenza test, you should code multiple units of 87804 when called for. For an in-office test that doesn’t identify the influenza strain, report one unit of 87804.

Can I report 87804 x 2 on my taxes?

Many carriers allow you to report 87804 x 2 without a problem since the MUEs that Medicaid and some other payers use to auto-deny second and subsequent line items limits you to two units of 87804. This means that your carrier will progress two units of the code but would most likely auto-deny three or more units billed together.

What is the fallback method for code 87804?

Fallback method: In some rare instances such as certain state Medicaid providers, you may be advised by your payer to use modifier 91 on the second listing of 87804. But then before going for this coding method, which contradicts present coding guidelines, obtain a written recommendation from the payer.


What modifier do I use for 87804?

Modifier 59Use Modifier 59 to Separate Tests Once you've determined that your provider performed an 87804 flu test, you're ready to check if she tested for both strains A and B of the flu. When your provider performs this test in the office for both flu strains A and B, you'll be able to report 87804 twice.

How do you bill for rapid flu test A and B?

The CPT® code modifier 59 is used to identify a distinct procedural service. In the context of influenza immunoassay testing, it supports coding CPT® 87400 once for influenza type A and once for influenza type B.

What does CPT code 87804 mean?

Infectious agent antigen detection by immunoassayCPT® Code 87804 in section: Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation.

What is the CPT code for rapid Covid test?

Feb. 21, 2022: Addition of code 87913 to report severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) mutation identification in targeted region(s).

What is the 91 modifier used for?

Repeat clinical diagnostic laboratory testModifier 91 is defined by CPT® as representative of Repeat clinical diagnostic laboratory test, and is used to indicate when subsequent lab tests are performed on the same patient, on the same day in order to obtain new test data over the course of treatment.

What is the ICD 10 code for flu?

ICD-10-CM Code for Influenza due to other identified influenza virus with other respiratory manifestations J10. 1.

Can CPT code 87804 be billed twice?

Medical Association's CPT and RBRVS 2021 Annual Sym- posium, the speakers indicated that a unique CPT would be considered as one point regardless of the number of times it is billed. For example, CPT 87804 is billed twice if both an in- fluenza A and B test are ordered. This would be counted as only one order.

What is the ICD 10 code for rapid flu test?

Influenza due to unidentified influenza virus with other respiratory manifestations. J11. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

How do you bill for a strep test?

CPT CODE 87880, 87561 – strep test.

What is the ICD 10 code for Covid testing?

Currently, there are no specific ICD-10 codes to use when billing for services related to COVID-19. The CDC has provided the following coding guidelines for COVID-19. B97. 29, Other coronavirus as the cause of diseases classified elsewhere.

What is the ICD 10 code for Covid antibody test?

There are three codes for COVID-19 testing: 87635 is designed to detect the COVID-19 virus and effective March 13, 2020, and 86328 and 86769 will be used to identify the presence of antibodies to the COVID-19 virus and are effective April 10, 2020.

What is QW modifier?

Modifier QW is defined as a Clinical Laboratory Improvement Amendment (CLIA) waived test. Some things to keep in mind when appending modifier QW to your lab service/s: The modifier is used to identify waived tests and must be submitted in the first modifier field.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA) §1833 (e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim

Article Guidance

To avoid the overuse of antibiotics and the potential risk of antibiotic resistance, point of care providers should consider testing patients prior to prescribing treatment for a bacterial or influenza infection. Influenza testing (using molecular methods) is recommended for hospitalized patients with suspected influenza.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.


Aetna considers rapid diagnostic tests for viral influenza (e.g., Directigen Flu A, Directigen Flu A+B, Flu OIA, Quickvue Influenza Test, and Z Stat Flu) medically necessary.


In the context of an epidemic, the clinical diagnosis of influenza in a patient with fever, malaise, and respiratory symptoms can be made with some certainty. In the absence of an epidemic of influenza, however, the diagnosis may be uncertain.

The above policy is based on the following references

Antoniol S, Fidouh N, Ghazali A, et al; Emergency Department study group on respiratory viruses. Diagnostic performances of the Xpert® Flu PCR test and the OSOM® immunochromatographic rapid test for influenza A and B virus among adult patients in the Emergency Department. J Clin Virol. 2018;99-100:5-9.