Update to Claims Logic: Rapid Antigen Diagnostic Testing (RADT) for Streptococcal Infection

Update to Claims Logic: Rapid Antigen Diagnostic Testing (RADT) for Streptococcal Infection

3/13/2019

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan have recently reviewed how our claims system applies benefits for RADT for streptococcal infection in symptomatic children. The CPT code 87880 was applying age criteria for symptomatic pediatric patients which caused inaccurate denials for dates of service beginning Feb. 1, 2019. This criteria has been updated and the impacted claims have been identified. If you’ve been impacted by this issue, upcoming remittances will reflect the appropriate benefits for this test. Please note that the medical criteria outlined in the relevant medical policy, CAM 211: β-Hemolytic Streptococcus Testing, is current. Please refer to this medical policy for additional information.

If you have questions about this bulletin please contact Provider Relations and Education by submitting the Provider Education Contact Form or by calling 803-264-4730 and a knowledgeable education specialist will respond.