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When it comes to billing for strep testing, the antibody rapid tests get billed under CPT code 87880 while the molecular detection tests get billed under 87651 as of 2026. For the reimbursement to be correct, the claim must be documented correctly, the correct modifiers must be used, and the claim must be CLIA compliant. Strep testing providers must be able to prove medical necessity and adhere to the reimbursement guidelines of the payers to prevent claim denials.
A provider’s ability to code and bill for strep testing accurately is critical to physician practices, urgent care facilities, and labs as we enter 2026. Providers have to consider the constant changes in CPT codes, payer reimbursement policies, and compliance guidelines, in order to properly code and bill the strep testing services. Proper coding and billing aids in the collection of revenue within compliance, minimizes the rate of denial, and adherence to the payer’s and governmental regulations. The goal of this guide is to provide information on the strep testing service CPT codes, strep testing service codes and billing requirements, and strep testing billing and reimbursement updates that are relevant to 2026.
.Strep Testing and Its Clinical Value
Strep testing is done to diagnose an infection caused by Group A Streptococcus (GAS) bacteria which causes an infection in your throat called strep throat. It can happen to adults and kids. If strep throat is not diagnosed and treated, it can lead to the serious condition called rheumatic fever. On the other hand, if it is diagnosed and treated, it can lead to too many antibiotics being prescribed to someone to treat a sickness that is caused by a virus.
If strep tests are done, it is because the provider sees the signs that may indicate that the patient may have strep throat. Signs of strep throat can include a sore throat, swollen lymph nodes, inflamed tonsils, a white throat (caused by pus), and a fever. There are two ways that testing can be done, and these are called Rapid Antigen Detection Tests and molecular/nucleic acid tests. Each of these tests can be done in order to achieve the results needed and each of these tests has a unique CPT code. This means that the patient will be charged differently for each test.
Key CPT Codes for Strep Testing in 2026
CPT Code 87880: Rapid Antigen Detection Test
CPT code 87880 is the most frequently reported code for rapid strep testing. It describes the immunoassay with a specific positive or negative optical readout, and is used for detecting the Group A Streptococcus antigen. This test is done in doctor’s offices, urgent care clinics, and outpatient settings, as it is a rapid test. With this test, providers can diagnose and treat patients during the same visit, which improves value and efficiency as well as the quality of care in the system.
This code is usually designated as a CLIA-waived test, meaning it can be done at any lab with a CLIA waiver certificate. For billing purposes with Medicare or some other payers, the provider must add modifier QW on the submission, and the provider’s CLIA certificate number must be on the claim. The documentation must, and should, clearly illustrate the patient’s symptoms, rationale for the test, and the results to substantiate the medical necessity.
CPT Code 87651: Molecular Strep Testing
CPT code 87651 is for reporting the nucleic acid detection testing for Group A Streptococcus. The test is a type of bacterial DNA detection using molecular technologies like PCR (Polymerase Chain Reaction). Molecular tests are superior to the rapid antigen tests, and are done more often when a rapid test is negative but clinical suspicion is high.
Most of the time, the testing is done at a laboratory, or an advanced diagnostic facility. Due to the high accuracy and advanced processing, the molecular tests get reimbursed more than the rapid antigen tests. In order to have proper documentation, the testing method, the clinical rationale, and the results must all be included and proper coding must be used to ensure reimbursement and avoid inconsistencies with the payer.
Culture Testing Codes
If a clinician suspects a Strep throat infection, they might do a Throat Culture. The process for culture testing involves growing bacteria from the throat, to identify if the bacteria is strep. The culture method may use the code 87081, from the various services provided to the patient. Culture testing is typically done if a rapid test is done, and the result is negative, but the clinician suspects a bacterial infection. Culture testing draws more attention from payers so be sure to explain the necessity of the culture to your documentation.
Billing and Documentation Requirements
Medical Necessity
When billing for strep testing, medical necessity is the most vital requirement. Payors typically look for the clinician’s documentation of the patient’s symptoms, and his/her clinical findings as evidence of medical necessity. In the case of strep infection testing, common symptoms are sore throat, fever, swollen lymph nodes, or inflamed tonsils. To conduct a strep test, a clinician must administer a clinical assessment and use their clinical judgment to justify the strep test.
Many strep test claims are denied because the documentation is insufficient. The testing must be diagnostic and treatment evidence, to support the Strep test. Proper documentation acts as protection for the provider in the case of an audit, and guarantees proper payment for an Strep test.
Modifier usage and how to comply with CLIA
Billing strep tests involve using modifiers. For tests that are CLIA-waived like CPT code 87880, modifier QW is used when required by the payer. This modifier shows that the test is done and is qualified for CLIA waiver tests.
Aside from providing the correct modifiers, CLIA certificate numbers are a must for each claim. Not providing the required modifiers and CLIA information would lead to having the claim denied or delayed so the claim for payment does not get processed. This is the responsibility of billing staff to check before the claim is submitted.
How to bill with Evaluation and Management (E/M) Services
Strep testing is done with patient office visits where evaluation and management services are included. For these incidents, the providers are able to bill for both the E/M code and the strep test code. In these situations, E/M services have to be clear and able to be distinguished from the laboratory test.
To determine if the evaluation service was separate from the testing procedure, providers are expected to add modifier 25 to the E/M code. There is a need to support the documentation for both services. Using modifiers correctly lowers chances payer disputes.
Reimbursement Considerations for 2026
Trends in Medicare Reimbursement
Strep testing Medicare reimbursement is impacted by the test type, where the test is performed, and if CLIA requirements are met. For tests that are performed quickly and easily, such as the rapid antigen tests, the reimbursement rates are lower than that of the molecular tests, which are more complex, but also more accurate. Because of this, the reimbursement is typically higher for molecular tests as opposed to rapid tests.
Because Medicare reimbursement rates change annually, providers are required to reference the Medicare Clinical Laboratory Fee Schedule. Knowledge in sped up Medicare reimbursement policies helps in accurate billing and receiving payments that are justified.
Reimbursement from Commercial Insurances
Billing for commercial insurance is very similar to billing Medicare; however, commercial insurance companies may have varying reimbursement rates and different policies regarding coverage. Additionally, some commercial insurance companies may require certain documentation, or may have coverage policies that are restricted to only situations that are deemed medically necessary.
Because of this, it is in the best interest of the providers to understand the policies of the payers in advance of any tests. Firm understanding of payer policies can increase both the rate of reimbursement and the rate of billing within the revenue cycle.
Reimbursement Determining Factors
Establish reasoning for reimbursement of strep tests from factors such as type of test performed, quality of documentation, use of appropriate modifiers, and the policies of the payer. Claims that are fulsomely documented and thoroughly reasoned capture the attention and reimbursement of the payer the fastest. For providers, increased financial performance and reduced administrative rage is the outcome of strong documentation and billing.
Common Mistakes in Billing and How to Avoid Them
Medicinal billing procedures have important tasks like documents detailing medical necessity. If this isn’t documented, the payer may deny the claim. Outstanding policies and procedures may be more difficult to follow because of missing policy modifiers or claim instructions, which help detail billing policies and procedures.
Problems will exist simply because of poor coding, the use of old billing codes, and the unbundling (billing separately) of multiple tests. The value of internal audits and routine staff training cannot be overstated, as internal audits help staff identify issues and staff training help staff recognize.
Best Practices 2026 Updates
Be aware of the billing rules, updates to payer policies, and updates to CPT codes as you manage your healthcare provider practice. The main strep testing CPT codes will remain stable, however, numerous policies and guidelines will change. Annually updating your billing procedures to be in compliance with codes is essential. This can be achieved by providing ongoing training to your staff.
Denial trends can give you valuable insights to improve your billing processes. If used right, EHR systems can help with the documentation and coding accuracy. For effective revenue cycle management, clinical and billing staff communication must be successful.
Final Thoughts
The importance of testing for strep throat is high when it comes to diagnosing/billing infections, as well as equally important for outlining the correct reimbursement. For 2026, the primary codes for rapid antigen and molecular testing are 87880 and 87651, respectively. For billing to be successful, all documentation has to be precise, all modifiers have to be used, and all policy guidelines have to be followed. Healthcare providers understand the importance of coding updates, documentation, and attention to detail when it comes to decreasing claim denials and reimbursement issues. Providers have effective billing, coding, and documentation to be compliant with regulations, ensure financial viability, and support quality patient care.
Make An Appintment With A2ZFAQs
The most commonly used CPT code for rapid strep testing is **87880**. This code describes an immunoassay with a positive Group A Strep optical sensor. This code is often seen in physician offices, urgent care offices, and outpatient facilities because they get results quickly, and the patient can get diagnosed and treated on the same day.
CPT code 87651 is used when a molecular test (such as PCR) is performed to determine the presence of Group A Strep. This test is considered to be more sensitive than rapid antigen testing.
Yes, modifier QW is required when billing CLIA waived strep tests, such as CPT code 87880, when billing Medicare and certain other payers. This modifier is used to indicate that the test is CLIA waiver compliant.
Yes, when a visit and a strep test are performed on the same day, the provider can charge for both an Evaluation and Management (E/M) visit and a strep test If the visit is medically necessary and can be the contrary reason.
The primary reasons are lack of supporting documents for medical necessity, wrong CPT codes, failure to use needed modifiers, and lack of CLIA. Accurate and thorough documentation and coding are the keys to minimizing denials and expediting payment.