Respiratory Viral Panel Testing CPP 161 Update

4/28/26

Dear Provider,

WellCare of Kentucky is updating its payment policy for respiratory viral panel testing effective on June 1, 2026.

Summary of CPP-161:

Consistent with the Centers for Medicare and Medicaid Services (CMS) Local Coverage Determinations (LCDs), WellCare of Kentucky considers Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels, including six or more pathogens not eligible for reimbursement.

Effective with dates of service beginning June 1, 2026, WellCare will not reimburse for multiplex reverse-transcription polymerase chain reaction (RT-PCR) assays (respiratory viral testing panels), CPT codes (0115U, 0202U, 0223U, 0225U, 87632 and 87633), submitted for reimbursement on professional and facility claim forms.

WellCare will consider CPT codes 87632 and 87633 in a facility (UB-04) Emergency Room, Observation and/or Inpatient setting for reimbursement.

You may find a copy of this policy on our website at https://www.wellcareky.com/providers/medicaid/claims/payment-policy.html.

 Thank you for your continued partnership and your commitment to delivering quality health care to our members. If you have any questions regarding this notice, please contact your Provider Relations Representative.

Sincerely,

WellCare of Kentucky