Effective for any DOS August 2025 and thereafter Point of Care testing for Syphilis is covered for all fee fo service Medicaid and Managed Medicaid Members.
Where is this test covered (POS)?
physician/nurse practitioner/licensed midwife private office setting
What kind of POC is covered and reimbursed?
Currently there is only one FDA approved test -Clinical Laboratory Improvement Amendments-waived, rapid syphilis test, Syphilis Health Check™, for the detection of Treponema pallidum antibodies.
Coding:
86780 – Antibody; Treponema pallidum.
Reimbursement Rates:
Physician- https://www.emedny.org/ProviderManuals/Physician/ – select medicine fee schedule
Midwife- https://www.emedny.org/ProviderManuals/Midwife/ select fee schedule
Nurse Practitioner- https://www.emedny.org/ProviderManuals/NursePractitioner/
For more guidance on which providers are allowed reimbursement please read the NYS PDF file here.
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