2025 Coding Reference

Fee schedules do not reflect 2% Payment Adjustment (Sequestration).
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Infectious Disease
COVID-19
CLIA Waived
Oncology/Genetics
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DEX Z-Code® Sharing Instructions for Cepheid Tests



COVID-19
Test Name
CPT® Code
 Description
LOINC Code
Medicare Coverage
National
Medicare Reimbursement
National
Medicaid Reimbursement
Xpert® Xpress SARS-CoV-2
AND
Xpert® Xpress CoV-2 plus

For emergency use under an Emergency Use Authorization (EUA)
87635-QW
 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique
94500-6
  CCI   MUE  
$ 51.31
N/A
Xpert® Xpress CoV-2/Flu/RSV
AND
Xpert® Xpress CoV-2/Flu/RSV plus

For emergency use under an Emergency Use Authorization (EUA)
0241U-QW
(all targets ordered)
 Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected
95941-1
Results
94500-6 SARS-CoV-2 (COVID-19) RNA [Presence] in Respiratory specimen by NAA with probe detection
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92142-9Influenza virus A RNA [Presence] in Respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92141-1Influenza virus B RNA [Presence] in Respiratory specimen by NAA with probe detection
92131-2Respiratory syncytial virus RNA [Presence] in Respiratory specimen by NAA with probe detection
  CCI   MUE  
$142.63
N/A
0240U-QW
(If only SARS CoV-2 / Flu is ordered)
 Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected
95422-2
Results
94500-6 SARS-CoV-2 (COVID-19) RNA [Presence] in Respiratory specimen by NAA with probe detection
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92142-9Influenza virus A RNA [Presence] in Respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
92141-1Influenza virus B RNA [Presence] in Respiratory specimen by NAA with probe detection
  CCI   MUE  
$142.63
N/A
87635-QW
(If only SARS CoV-2 is ordered)
 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique
94500-6
  CCI   MUE  
$ 51.31
N/A


Critical Infectious Disease
Test Name CPT® Code Description
LOINC Code
Medicare Coverage
National
Medicare Reimbursement
National
Medicaid Reimbursement
Xpert® HCV
CLIA Waived		 87521-QW hepatitis C, amplified probe technique, includes reverse transcription when performed
5010-4
  CCI   MUE  
$ 35.09
N/A



Respiratory Infections
Test Name CPT® Code Description
LOINC Code
Medicare Coverage
National
Medicare Reimbursement
National
Medicaid Reimbursement
Xpert® Xpress Flu
CLIA Waived
 87502-QW influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub-types
92882-0
Results
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
  CCI   MUE  
$ 95.80
N/A
Xpert® Flu+RSV
CLIA Waived
 87631-QW respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets
85476-0
Results
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
76089-2Respiratory syncytial virus RNA [Presence] in Nasopharynx by NAA with probe detection/td>
  CCI   MUE  
$142.63
N/A
Xpert® Xpress Flu/RSV CLIA Waived 87631-QW
(all targets ordered)		 respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets
85476-0
Results
76089-2 Respiratory syncytial virus RNA [Presence] in Nasopharynx by NAA with probe detection
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
  CCI   MUE  
$142.63
N/A
87502-QW
(If only Flu is ordered)		 influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub-types
92882-0
Results
85477-8Influenza virus A RNA [Presence] in Upper respiratory specimen by NAA with probe detection
85478-6Influenza virus B RNA [Presence] in Upper respiratory specimen by NAA with probe detection
  CCI   MUE  
$ 95.80
N/A
87634-QW
(If only RSV is ordered)		 respiratory syncytial virus, amplified probe technique
76089-2
  CCI   MUE  
$ 70.20
N/A
Xpert® Xpress Strep A
CLIA Waived
 87651-QW Streptococcus, group A, amplified probe technique
60489-2
  CCI   MUE  
$ 35.09
N/A


Women's Health/Sexual Health
Test Name CPT® Code Description
LOINC Code
Medicare Coverage
National
Medicare Reimbursement
National
Medicaid Reimbursement
Xpert® Xpress MVP
CLIA Waived		 81515-QW Infectious disease, bacterial vaginosis and vaginitis, real-time PCR amplification of DNA markers for Atopobium vaginae, Atopobium species, Megasphaera type 1, and Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), utilizing vaginal-fluid specimens, algorithm reported as positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata/Candida krusei, when reported
92703-8
Components
69568-4Bacterial vaginosis [Interpretation] in Vaginal fluid Qualitative
62460-1Candida sp DNA [Presence] in Vaginal fluid by NAA with probe detection
101571-8Candida glabrata+krusei DNA [Presence] in Vaginal fluid by NAA with probe detection
62461-9Trichomonas vaginalis DNA [Presence] in Vaginal fluid by NAA with probe detection
  MUE  
$262.99
N/A


^ For emergency use under an Emergency Use Authorization (EUA).

* This product has not been FDA cleared or approved, but has been authorized for emergency use by FDA under an EUA for use by the authorized laboratories; This product has been authorized only for the detection of nucleic acid from monkeypox virus or other non-variola orthopoxviruses, not for any other viruses or pathogens; and the emergency use of this product is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of infection with the monkeypox virus, including in vitro diagnostics that detect and/or diagnose infection with non-variola Orthopoxvirus, under Section 564(b)(1) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. ¤ 360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.

Healthcare policy, economics and reimbursement information provided by Cepheid is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Cepheid encourages providers to submit accurate and appropriate claims for services. It is the provider's responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services rendered. Cepheid recommends that providers consult with payers, reimbursement specialists and/or legal counsel regarding coding, coverage and payment matters.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this website. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of information is error-free or that the use of this information will result in coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

This material contains content from LOINC (http://loinc.org). LOINC is copyright © Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.

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04/02/2025 01:57:47 18.216.135.3