Overview
CPT® Code 87426 is used to report rapid antigen testing for SARS-CoV-2 (COVID-19) performed using a swab specimen. These tests detect viral proteins and are often used for point-of-care or rapid diagnostic testing. Unlike molecular PCR tests, antigen tests provide faster results but may be less sensitive, particularly in asymptomatic patients.
The code reflects the laboratory or point-of-care test itself. Interpretation and patient counseling are reported separately if provided.
Key Facts About CPT® 87426
- Service type: Clinical laboratory or point-of-care test
- Provider type: Physicians, qualified healthcare professionals, laboratories, or authorized testing sites
- Medical services included: Detection of SARS-CoV-2 antigen using a swab specimen
- Specimen type: Nasal, nasopharyngeal, or other FDA-approved swabs
- Common clinical indications:
- Symptomatic patients suspected of COVID-19
- Exposure or surveillance testing
- Pre-procedural screening
- Outbreak or contact tracing scenarios
When to Use CPT® 87426
CPT 87426 is appropriate when:
- A patient requires a rapid COVID-19 antigen test using a swab
- Testing is medically necessary for diagnosis, surveillance, or exposure evaluation
- Results are used to guide infection control measures, isolation, or treatment decisions
Examples:
- Symptomatic patient presents with fever and cough; rapid antigen testing is performed
- Preoperative COVID-19 screening for elective procedures
- Testing for exposure in a workplace or school outbreak
Documentation Requirements
To properly support CPT 87426 billing, documentation should include:
- Patient identifiers and date of testing
- Specimen type and collection method
- Indication for testing (symptomatic, exposure, surveillance)
- Test result and interpretation
- Any follow-up recommendations, isolation instructions, or treatment guidance
Accurate documentation ensures proper reimbursement, compliance, and record integration.
Reimbursement and Coding Considerations
- CPT 87426 is covered by most commercial insurers, Medicaid, and Medicare when medically necessary
- Interpretation or counseling must be billed separately
- Some payers may require additional modifiers for outpatient vs. point-of-care settings
- Always verify payer-specific policies, especially regarding rapid COVID-19 testing and reimbursement
How OptiMantra Supports COVID-19 Antigen Testing
OptiMantra’s integrated EMR and practice management system simplifies documentation, tracking, and billing for CPT 87426:
With OptiMantra, providers can:
- Record swab collection, patient information, and test results directly in the EMR
- Track trends, positive/negative rates, and patient follow-up over time
- Document patient counseling, isolation instructions, and infection control measures
- Generate clean, audit-ready billing codes for rapid claims submission
- Integrate COVID-19 testing with broader care plans and reporting requirements
By centralizing testing workflows, OptiMantra ensures accurate records, streamlined operations, and proper reimbursement for COVID-19 antigen testing.
Try OptiMantra for free here!
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