While this document represents our best efforts to provide you with guidance and useful advice, we cannot guarantee that third-party or government payers will recognize and accept our recommendations. The analysis of any medical or billing coding question is dependent upon numerous specific facts – including the factual situations present related to patients, the professionals, the medical services provided and the medical record documentation. 

In addition, laws and regulations and insurance and payer policies are subject to change. The information that has been accurately provided in the past could change depending upon changes in such laws or regulations. 

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Type: Compliance 

Response:  

Billing 87811 and 87804 separately is not appropriate to code when a combo test (87812) has been performed.  It is not compliant if that is not what was performed.  We must bill what was performed with the closest CPT that describes the service. 

Billing is based on how many cartridges are used.  If the flu and COVID test were performed on two separate cartridges, then 87811 and 87804 should be billed.  If one cartridge was used then 87812 is the CPT that best describes the service being performed, therefore it is what should be billed. 

Labs should not be split/unbundled due to: 

• Combo tests are FDA-approved and payer-recognized as a single diagnostic service 

• Unbundling is often considered duplicate or fragmented billing 

• Many payers treat unbundling as incorrect coding or potential overbilling 

Source: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00270304&utm= 

https://www.cms.gov/files/document/chapter10cptcodes80000-89999final11.pdf 

https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-september-25-2025#:~:text=For%20combination%20tests%20that%20are,bill%20CPT%20code%2087428%20QW. 

https://www.us-beacon.com/blog-post-title-17/?utm 

https://www.aapc.com/codes/cpt-codes/87812?srsltid=AfmBOorWd9T4nL0TLq7RDMj7JEkD12_giyrPMU7Oh6_sxlxb0HZLeXHY 

Signed: Tricia Krueger, CPC