MedicaidBilling CodesMedium impact
MAB2022032501
Pennsylvania Medicaid (DHS)·PA · Pathology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Mar 21, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has added two new CPT codes 87636 and 87637 for multiplex respiratory pathogen testing that simultaneously detects COVID-19 with influenza A/B and RSV. Both codes reimburse at $112.86 per test with a limit of once per day and require QW modifier for CLIA-waived facilities.
Action Required
Immediately: Billing team must add CPT codes 87636 and 87637 to billing system for Pennsylvania Medicaid patients with reimbursement rate of $112.86 per test. Configure system to limit billing to once per day per code. For facilities with CLIA certificate of waiver, ensure QW modifier is appended to both codes. Update encounter forms and lab billing templates to include these new multiplex respiratory pathogen testing codes.