Medicare covers anthrax testing in appropriate situations

• Medicare covers anthrax testing when reasonable and necessary and ordered by a physician.
• Medicare patients who believe they may have been exposed to anthrax may request testing to determine if they have the disease or have been exposed to the disease.  In this specific clinical situation, Medicare will cover the test and related services.  All usual rules regarding documentation for the reason for the test and the need for a written order apply.  As always, Medicare only covers testing necessary to diagnose and treat the patient.
• The culture should be coded using CPT code 87081.  The payment for obtaining the specimen is included in the E/M payment.
• When the testing is performed because the patient has had contact with or exposure to a communicable disease or biological agent, use ICD-9-CM code V01.8.  Only if the patient is confirmed to have disease caused by anthrax bacillus should codes from the anthrax series (022.1-022.9) be used.
• Medicare coverage of anthrax testing does not extend to mass testing performed by public health officials in response to a confirmed anthrax exposure.  However, Medicare will cover any subsequent medically appropriate and necessary diagnosis and treatment consistent with existing policy.

          Source:  CMS Communication to Medicare Contractors dated October 26, 2001.