Background 

Effective January 1, 2026, CMS introduced a new CPT code, 87812, specifically for “visually read” COVID-19 and Influenza A/B combination tests. This replaces the previous practice of billing two separate codes (87811 + 87804) for these manual test strips. 

Current Status 

Major payers, including Medicare and BCBS, are currently still paying the separate codes at the 2025 rates. However, this is likely a temporary delay in payer software updates. Continued use of the old codes poses a significant risk of future denials or audit “clawbacks.” 

Action Plan 

We must proactively align with the new standard immediately: 

Update Chargemaster: Configure the EMR to bill CPT 87812 for all visually read COVID/Flu combo tests. 

Stop Unbundling: Discontinue billing 87811 and 87804 together for single manual test kits. 

• Preserve Other Codes: Continue using existing codes for machine-read antigen tests or PCR tests, as these are unaffected. 

SEPARATE ISSUE: URGENT PCR DENIALS 

While analyzing the data for the policy change, a critical unrelated issue was discovered regarding PCR tests (CPT 87636). 

The Issue: In December, Medicare and UnitedHealthcare (UHC) paid consistently for this code. In January, payments from both payers dropped to $0 (100% denial rate) on closed claims. 

Immediate Recommendation: This is likely a “Medical Necessity” denial or a missing modifier issue (such as the “QW” modifier for CLIA-waived labs) that triggered with the new year. You should have the billing team pull a remittance advice for a January Medicare PCR claim immediately to identify the specific denial reason code. 

Revised Urgent Care Lab CPT List (2026 Update)