Fee schedule updates for respiratory panels
Effective Nov. 15
We’re revising the payment rate for large multiplex respiratory pathogen panels on Geisinger Health Plan comprehensive and laboratory fee schedules. Fee schedule changes are effective Saturday, Nov. 15. After a thorough evaluation we’ve determined these changes will allow us to more accurately balance member benefits with the cost of services.
Codes and plans affected
Fee schedule changes will apply to the following:
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CPT code 87633 describes a Respiratory Viral Panel using nucleic acid amplification to detect 12 to 25 viral targets in a multiplex reaction.
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CPT code 0202U is a proprietary laboratory analysis (PLA) code for the BioFire® FilmArray® Respiratory Panel 2.1 (RP2.1). This test is a qualitative, real-time polymerase chain reaction (RT-PCR) assay that detects 22 bacterial and viral respiratory pathogens, including SARS-CoV-2 (the virus that causes COVID-19), from a single nasopharyngeal swab.
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These fee schedule changes will apply to all plans, including Geisinger Gold and GHP Family (Medicaid).
Unexpected costs to members
As we enter the winter months, members who see their healthcare provider for a respiratory illness may end up paying a lot for what they thought was a simple test. Depending on their benefit structure, some are finding they owe way more than they expected.
Respiratory panels are often necessary — and even requested by patients who think they may have the flu or COVID. But patients should understand broadly that there are associated costs, even for seemingly simple swabs, so they can make informed decisions.
When you offer respiratory testing options to your patients, be sure to remind them that testing could have a significant impact on their deductible and out-of-pocket costs.
