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The purpose of this memorandum is to inform providers that DMAS fee for service (FFS) and all contracted managed care plans will cover two new COVID-19 antibody-testing codes. Please check with the individual plan for details on service authorization. Further contact information is included at the bottom of this document.  
 
The two antibody testing codes below will be covered with effective dates of service of August 10, 2020 and onwards. Laboratories billing for these codes will need to be CLIA-certified.  

•      86769: Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and  
•      86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, singlestep method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) the codes. 
   

For members enrolled in the FFS program, DMAS will reimburse providers for COVID-19 antibody testing under the following conditions: 

• Providers have ensured that the serologic assays used for testing: o     Have     Emergency     Use     Authorization     (EUA)     by     the     FDA:   https://www.fda.gov/medical-devices/emergency-situations-medical-devices/euaauthorized-serology-test-performance; and 
  • Have a sensitivity and specificity > 98% and a Positive Predictive Value of > 90% (at an assumed prevalence of 5%). 
• The purpose of testing meets either one (1) of the following criteria: 
  • Used as a method to help establish a diagnosis when patients present with late complications of COVID-19 illness. 
• When used in addition to direct detection methods, such as polymerase chain reaction (PCR) to aid in the evaluation of acute COVID-19 illness for patients who present late in the disease course (currently defined as > 14 days after illness onset). The PCR test must be performed, and the result returned, before antibody testing is performed. 

The reimbursement rate for these codes will be: 86769 = $42.13; 86328 = $45.23

For members enrolled in the FFS program, the DMAS Medical Support Unit (MSU) will be completing the authorization requests. Providers must fax authorization requests for the test to the DMAS Medical Support Unit (MSU). The MSU fax number is 804-452-5450.  
 
For questions on completing authorization requests for members enrolled in a managed care organization, refer to the contact information listed below.