State of Alabama
07/11/2025 | Press release | Distributed by Public on 07/11/2025 10:01
Respiratory Pathogen Panel Tests (CPT 87631 – 87633) Coverage Update
TO: Physicians, Independent Labs, Hospitals and Other Lab Providers
RE: Respiratory Pathogen Panel Tests (CPT 87631 - 87633) Coverage Update
A panel test is a single test with multiple components. Effective on or after August 1, 2025, the following changes will take effect:
CPT 87631-87633 may only be billed as one unit per date of service
CPT 87632 and 87633 may only be filed on outpatient (UB-04) claims for place of service (POS) 19, 21, 22, and 23:
|
POS Code |
POS Code Description |
|
19 |
OFF CAMPUS - OUTPATIENT HOSPTIAL |
|
21 |
INPATIENT HOSPITAL |
|
22 |
ON CAMPUS - OUTPATIENT HOSPITAL |
|
23 |
EMERGENCY ROOM |
The following list of codes may not be billed with CPT 87154, 87505-87507, 87631-87633, 87636, 87637, 87800, 87801:
|
CPT Code |
CPT Description |
CPT Code |
CPT Description |
|
|
87149 |
DNA/RNA DIRECT PROBE |
87534 |
HIV-1 DNA DIR PROBE |
|
|
87150 |
DNA/RNA AMPLIFIED PROBE |
87535 |
HIV-1 PROBE&REVERSE TRNSCRPJ |
|
|
87471 |
BARTONELLA DNA AMP PROBE |
87536 |
HIV-1 QUANT&REVRSE TRNSCRPJ |
|
|
87475 |
LYME DIS DNA DIR PROBE |
87537 |
HIV-2 DNA DIR PROBE |
|
|
87476 |
LYME DIS DNA AMP PROBE |
87538 |
HIV-2 PROBE&REVRSE TRNSCRIPJ |
|
|
87480 |
CANDIDA DNA DIR PROBE |
87539 |
HIV-2 QUANT&REVRSE TRNSCRIPJ |
|
|
87481 |
CANDIDA DNA AMP PROBE |
87540 |
LEGION PNEUMO DNA DIR PROB |
|
|
87482 |
CANDIDA DNA QUANT |
87541 |
LEGION PNEUMO DNA AMP PROB |
|
|
87485 |
CHLMYD PNEUM DNA DIR PROBE |
87550 |
MYCOBACTERIA DNA DIR PROBE |
|
|
87486 |
CHLMYD PNEUM DNA AMP PROBE |
87551 |
MYCOBACTERIA DNA AMP PROBE |
|
|
87490 |
CHLMYD TRACH DNA DIR PROBE |
87555 |
M.TUBERCULO DNA DIR PROBE |
|
|
87491 |
CHLMYD TRACH DNA AMP PROBE |
87556 |
M.TUBERCULO DNA AMP PROBE |
|
|
87493 |
C DIFF AMPLIFIED PROBE |
87560 |
M.AVIUM-INTRA DNA DIR PROB |
|
|
87495 |
CYTOMEG DNA DIR PROBE |
87561 |
M.AVIUM-INTRA DNA AMP PROB |
|
|
87496 |
CYTOMEG DNA AMP PROBE |
87580 |
M.PNEUMON DNA DIR PROBE |
|
|
87497 |
CYTOMEG DNA QUANT |
87581 |
M.PNEUMON DNA AMP PROBE |
|
|
87498 |
ENTEROVIRUS PROBE&REVRS TRNS |
87590 |
N.GONORRHOEAE DNA DIR PROB |
|
|
87501 |
INFLUENZA DNA AMP PROB 1+ |
87591 |
N.GONORRHOEAE DNA AMP PROB |
|
|
87502 |
INFLUENZA DNA AMP PROBE |
87592 |
N.GONORRHOEAE DNA QUANT |
|
|
87503 |
INFLUENZA DNA AMP PROB ADDL |
87623 |
HPV LOW-RISK TYPES |
|
|
87510 |
GARDNER VAG DNA DIR PROBE |
87624 |
HPV HIGH-RISK TYPES |
|
|
87511 |
GARDNER VAG DNA AMP PROBE |
87625 |
HPV TYPES 16 & 18 ONLY |
|
|
87512 |
GARDNER VAG DNA QUANT |
87634 |
RSV DNA/RNA AMP PROBE |
|
|
87516 |
HEPATITIS B DNA AMP PROBE |
87635 |
SARS-COV-2 COVID-19 AMP PRB |
|
|
87517 |
HEPATITIS B DNA QUANT |
87640 |
STAPH A DNA AMP PROBE |
|
|
87520 |
HEPATITIS C RNA DIR PROBE |
87641 |
MR-STAPH DNA AMP PROBE |
|
|
87521 |
HEPATITIS C PROBE&RVRS TRNSC |
87650 |
STREP A DNA DIR PROBE |
|
|
87522 |
HEPATITIS C REVRS TRNSCRPJ |
87651 |
STREP A DNA AMP PROBE |
|
|
87525 |
HEPATITIS G DNA DIR PROBE |
87653 |
STREP B DNA AMP PROBE |
|
|
87526 |
HEPATITIS G DNA AMP PROBE |
87660 |
TRICHOMONAS VAGIN DIR PROBE |
|
|
87528 |
HSV DNA DIR PROBE |
87661 |
TRICHOMONAS VAGINALIS AMPLIF |
|
|
87529 |
HSV DNA AMP PROBE |
87797 |
DETECT AGENT NOS DNA DIR |
|
|
87530 |
HSV DNA QUANT |
87798 |
DETECT AGENT NOS DNA AMP |
|
|
87531 |
HHV-6 DNA DIR PROBE |
U0001 |
2019-NCOV DIAGNOSTIC P |
|
|
87532 |
HHV-6 DNA AMP PROBE |
U0002 |
COVID-19 LAB TEST NON-CDC |
|
|
87533 |
HHV-6 DNA QUANT |
|
|
Medical record documentation must support the use of any submitted CPT codes on a claim.
Providers with policy questions may contact Medical Services at medicalservices@medicaid.alabama.gov .
Providers with billing questions should contact the Gainwell Technology Provider Assistance Center at
1-800-688-7989.
The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 20 25 American Medical Association
and © 20 25 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.
State of Alabama published this content on July 11, 2025, and is solely responsible for the information contained herein. Distributed via Public Technologies (PUBT), unedited and unaltered, on July 11, 2025 at 16:01 UTC. If you believe the information included in the content is inaccurate or outdated and requires editing or removal, please contact us at support@pubt.io