With October essentially being the first full month in fall, many of us are enjoying changes in the leaves or are thinking about the excitement of Halloween and other fall events to come. With that being said, October is also a good time to plan for the upcoming winter season. Starting in October, instances of Strep and Flu A/B are typically on the rise, in addition to the continuous management of COVID-19. The practice should assess the testing approach and make any necessary changes. Please notify your account manager to discuss any changes made in the practice approach to help determine if any changes need to be made related to billing codes.
Choices for an office setting include antigen testing and molecular testing. Note that both types of testing can be performed by a Pediatric Office that maintains a status as a “CLIA waived” laboratory (usual lab destination for a pediatric office.) There are differences in equipment, cost, and accuracy between the two. Some key points to consider when evaluating antigen testing vs. molecular testing include:
- Evaluate the cost and reimbursement of options that are available for both choices. Medical suppliers Medline and McKesson have a full line of antigen or molecular testing options available for Strep, COVID-19, and Flu A/B.
- For antigen testing, the cost of the rapid Strep test is in the $1-$2 range, CPT code 87880. Generally, insurance companies reimburse for rapid Strep testing at a rate of $6 to $14 above the cost of the test (depending upon the insurance carrier.) The cost of the rapid Flu A/B tests are typically between $10-$13, CPT code 87804. On average, rapid Flu tests are reimbursed at a rate of $8 to $15 above the cost of the test. While the costs and reimbursements have varied for the COVID-19 rapid antigen, the COVID-19 rapid antigen test (CPT code 87426) is typically reimbursed at a rate of $8 and $12 above the cost of the test.
- For molecular testing, the cost is typically higher. This could result in a higher profit margin, but may potentially result in a lower profit margin dependent upon the payer. Some payers only reimburse for antigen rapid tests, so it is important to evaluate the reimbursement from payers in your pediatric practices prior to making a decision.
There is a more detailed review of antigen and molecular testing options in a previous article written by the Physician Xpress team. Each Pediatric practice should complete this analysis and select the approach that best meets their respective needs.