How To Use CPT Code 86328

CPT 86328 is a single-step immunoassay for detecting antibodies to the SARS-CoV-2 virus, which causes COVID-19. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 86328 procedures.

1. What is CPT 86328?

CPT 86328 is a code used to report a single-step immunoassay for detecting antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease first identified in 2019 (COVID-19). This test is performed to evaluate a patient’s specimen for antibodies to the virus, which can help identify past infections and potential blood plasma donors for treating current COVID-19 patients.

2. 86328 CPT code description

The official description of CPT code 86328 is: “Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])”.

3. Procedure

The 86328 CPT code procedure involves the following steps:

1. Collection of the patient’s blood sample, typically whole blood or serum.
2. Preparation of the sample for testing, which may include separation of serum from whole blood.
3. Performing the single-step immunoassay using a reagent strip containing specific antigens, such as an IgG/IgM reagent strip.
4. Observation of a color change in the reagent strip, indicating the presence of antibodies to SARS-CoV-2 in the patient’s sample.
5. Interpretation of the test results as qualitative or semiquantitative, based on the intensity of the color change.
6. Documentation of the test results and communication to the ordering clinician.

4. Qualifying circumstances

Patients eligible to receive CPT code 86328 services include those who:

• Have a history of COVID-19 symptoms or exposure to the virus.
• Require evaluation for past SARS-CoV-2 infection for follow-up care or treatment planning.
• Are being screened as potential blood plasma donors for the treatment of current COVID-19 patients.
• Are part of a population-based study or surveillance program for COVID-19.

5. When to use CPT code 86328

It is appropriate to bill the 86328 CPT code when a single-step immunoassay is performed to detect antibodies to the SARS-CoV-2 virus in a patient’s specimen. This code should be used for point-of-care tests that use a reagent strip with all the critical components for the antibody assay. Report 86328 only once, even if a single reagent strip tests for more than one class of antibody; however, if multiple reagents strips are used, you can report the code times the number of reagent strips used.

6. Documentation requirements

To support a claim for CPT 86328, the following information should be documented:

• Patient’s demographic information, including name, date of birth, and medical record number.
• Ordering clinician’s information, including name, contact details, and National Provider Identifier (NPI) number.
• Indication for the test, such as evaluation for past SARS-CoV-2 infection or screening for potential blood plasma donors.
• Date and time of the specimen collection.
• Type of specimen collected (e.g., whole blood or serum).
• Details of the single-step immunoassay performed, including the reagent strip used and the method of interpretation (qualitative or semiquantitative).
• Test results, including the presence or absence of antibodies to SARS-CoV-2 and any relevant interpretation or recommendations based on the results.

7. Billing guidelines

When billing for CPT code 86328, keep in mind the following guidelines and tips:

• Report 86328 only once, even if a single reagent strip tests for more than one class of antibody. If multiple reagent strips are used, report the code times the number of reagent strips used.
• For SARS-CoV-2 antibody testing using a multistep method, use CPT code 86769 instead.
• For SARS-CoV-2 DNA or RNA detection by nucleic acid, amplified probe technique, use CPT code 87635.
• For SARS-CoV-2 antigen detection by immunoassay, use CPT code 87426.
• Some payers may pay separately for collecting the specimen using a code such as 36415.

8. Historical information

CPT 86328 was added to the Current Procedural Terminology system on April 10, 2020. There have been no updates to the code since its addition.

9. Similar codes to CPT 86328

Five similar codes to CPT 86328 and how they differentiate are:

• CPT 86318: This parent code is for immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, not otherwise specified.
• CPT 86769: This code is for SARS-CoV-2 antibody testing using a multistep method, rather than the single-step method used in CPT 86328.
• CPT 87635: This code is for SARS-CoV-2 DNA or RNA detection by nucleic acid, amplified probe technique, which is a different testing method than the immunoassay used in CPT 86328.
• CPT 87426: This code is for SARS-CoV-2 antigen detection by immunoassay, which tests for the presence of the virus itself rather than the antibodies to the virus as in CPT 86328.
• HCPCS U0001 and U0002: These codes are for laboratory testing for the SARS-CoV-2 virus, with U0001 specifically for the CDC-developed kit and U0002 for tests developed by other labs.

10. Examples

Here are 10 detailed examples of CPT code 86328 procedures:

1. A patient with a history of COVID-19 symptoms is tested for antibodies to SARS-CoV-2 using a single-step immunoassay with a reagent strip.
2. A healthcare worker who was exposed to COVID-19 patients undergoes antibody testing using a single-step immunoassay to determine past infection.
3. A patient who recovered from COVID-19 is tested for antibodies to SARS-CoV-2 to evaluate their eligibility for donating blood plasma for the treatment of current COVID-19 patients.
4. A participant in a population-based study on COVID-19 undergoes antibody testing using a single-step immunoassay with a reagent strip.
5. A patient with a history of COVID-19 symptoms is tested for both IgG and IgM antibodies to SARS-CoV-2 using a single reagent strip in a single-step immunoassay.
6. A patient who was in close contact with a confirmed COVID-19 case undergoes antibody testing using a single-step immunoassay to determine past infection.
7. A healthcare worker who received the COVID-19 vaccine is tested for antibodies to SARS-CoV-2 using a single-step immunoassay to evaluate their immune response to the vaccine.
8. A patient who recovered from COVID-19 is tested for antibodies to SARS-CoV-2 using a single-step immunoassay as part of their follow-up care and treatment planning.
9. A patient with a history of COVID-19 symptoms undergoes antibody testing using a single-step immunoassay with two separate reagent strips for IgG and IgM antibodies.
10. A participant in a surveillance program for COVID-19 undergoes antibody testing using a single-step immunoassay with a reagent strip to monitor the prevalence of past infections in the community.