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Effective January 1, 2026, the Centers For Medicare and Medicaid Services mandated a critical coding change for urgent care: Visually read COVID-19/flu combination tests must now be billed under the single code CPT 87812. This replaces the previous standard of unbundling the tests into 2 separate codes (CPT 87811 and CPT 87804) and was intended to be revenue-neutral. However, a national analysis of January 2026 data by Urgent Care Consultants exclusively for JUCM reveals a chaotic implementation landscape. Currently, 66% of urgent care visits are still billing the discontinued separate codes. While this noncompliance temporarily avoids reimbursement glitches for urgent cares, it creates exposure for future audits and claw-backs. The data also shows a split reality in payer readiness. Major commercial payers and Medicaid have successfully adopted the new standard, reimbursing the single code at the expected aggregate rate. However, some national payers have failed to integrate the new fee schedules, resulting in massive underpayments—in some cases, paying less than $2 for the combined test or devaluing the reimbursement by more than 60%.
Action item: Operators must transition to CPT 87812 to remain compliant but should immediately audit their January remittances to identify and appeal these systemic payer errors, according to Alan A. Ayers, MBA, MAcc, President of Urgent Care Consultants and Senior Editor of JUCM.