Billing Respiratory Pathogen Panels: 87631-87633

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Code sets: CY 2026 CPT; Medicare LCD L38916 and Article A58575.

The question

A lab runs a large respiratory panel, and the payer will not cover it. Can the lab bill a smaller panel code, or two smaller panels, instead?

The codes

  • 87631 Respiratory virus panel, 3-5 targets.

  • 87632 6-11 targets.

  • 87633 12-25 targets.

  • 87636 SARS-CoV-2 and influenza A and B; 87637 adds RSV.

Choose the code by the number of targets the test actually detects.

Medicare coverage

Under the MolDX and Novitas/First Coast LCDs, panels of five or fewer respiratory pathogens are covered in the outpatient setting when the criteria are met. Panels of more than five pathogens are not considered medically reasonable and necessary in the Part B outpatient setting, so 87632 and 87633 are non-covered there (First Coast Service Options). Some MolDX policies allow expanded panels for specific critically ill or immunocompromised patients.

You cannot split a panel

A respiratory pathogen panel is a single service with one unit of service. It must not be unbundled into individual components, and "panel" means all respiratory pathogens tested on a single date of service from a single specimen, unless ordered as a reflex test (CMS Billing and Coding Article A58575). Billing a 12-target test as two 3-5 target panels, or as 87631 to get paid, misrepresents the service.

When the large panel is not covered

  • Bill the code for the test that was performed.

  • For Medicare, use the appropriate modifier for a non-covered service, and an ABN (modifier GA) when the patient was properly notified in advance.

  • Encourage ordering providers to choose a targeted panel (87631, 87636, 87637) when it fits the clinical situation.

Commercial payers

Many follow similar rules. For example, UnitedHealthcare's commercial policy considers outpatient panels of six or more targets unproven and not medically necessary (UnitedHealthcare policy). Always check the specific plan policy.

Refreshed from the CCO Community archive, November 2026.