New York State Medicaid Expansion of Coverage of Group A Streptococcus Testing for Practitioners

Date Issued: 3/29/2016

Effective April 1, 2016, Medicaid Managed Care (MMC) begins reimbursing practitioners for Group A Streptococcus testing (CPT code 87651) when performed in a practitioner’s office (POS 11).

When billed with POS 11, the qualifying provider types are: midwives, nurse practitioners and all physicians. There are two testing methods for this code:

• 8 minute test (less complex)
• one hour (more complex)

Choice of testing method is at the provider’s discretion.

The purpose of this expansion is to obtain faster test results in an office setting. Point of care testing for Group A Streptococcal infection often allows practitioners to determine an appropriate course of treatment during an initial visit.

Currently, CPT code 87651 is also covered in an independent lab setting when billed with POS 81.