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Medicare Reimbursement: CMS Publishes New CPT Codes

CMS recently published new CPT codes taking effect on Oct. 1, 2019. All the codes have a Type of Service (TOS) code of 5, and the codes are contractor-priced until they appear on the Jan. 1, 2020 CLFS as applicable. MACs will only price Proprietary Laboratory Analysis (PLAs) codes for laboratories within their jurisdiction.

CPT Code Long Descriptor Short Descriptor
0105U Nephrology (chronic kidney disease), multiplex electrochemiluminescent immunoassay (ECLIA) of tumor necrosis factor receptor 1A, receptor superfamily 2 (TNFR1, TNFR2), and kidney injury molecule-1 (KIM1) combined with longitudinal clinical data, including APOL1 genotype if available, and plasma (isolated fresh or frozen), algorithm reported as probability score for rapid kidney function decline (RKFD) NEPH CKD MULT ECLIA TUM NEC
0106U Gastric emptying, serial collection of 7 timed breath specimens, non-radioisotope carbon-13 (13C) spirulina substrate, analysis of each specimen by gas isotope ratio mass spectrometry, reported as rate of 13CO2 excretion GSTR EMPTG 7 TIMED BRTH SPEC
0107U Clostridium difficile toxin(s) antigen detection by immunoassay technique, stool, qualitative, multiple-step method C DIFF TOX AG DETCJ IA STOOL
0108U Gastroenterology (Barrett’s esophagus), whole slide–digital imaging, including morphometric analysis, computer-assisted quantitative immunolabeling of 9 protein biomarkers (p16, AMACR, p53, CD68, COX-2, CD45RO, HIF1a, HER-2, K20) and morphology, formalin-fixed paraffin- embedded tissue, algorithm reported as risk of progression to high-grade dysplasia or cancer GI BARRETT ESOPH 9 PRTN BMRK
0109U Infectious disease (Aspergillus species), real-time PCR for detection of DNA from 4 species (A. fumigatus, A. terreus, A. niger, and A. flavus), blood, lavage fluid, or tissue, qualitative reporting of presence or absence of each species ID ASPERGILLUS DNA 4 SPECIES
0110U Prescription drug monitoring, one or more oral oncology drug(s) and substances, definitive tandem mass spectrometry with chromatography, serum or plasma from capillary blood or venous blood, quantitative report with steady-state range for the prescribed drug(s) when detected RX MNTR 1+ORAL ONC RX
0111U Oncology (colon cancer), targeted KRAS (codons 12, 13, and 61) and NRAS (codons 12, 13, and 61) gene analysis utilizing formalin-fixed paraffin-embedded tissue ONC COLON CA KRAS&NRAS ALYS
0112U Infectious agent detection and identification, targeted sequence analysis (16S and 18S rRNA genes) with drug- resistance gene IADI 16S&18S RRNA GENES
0113U Oncology (prostate), measurement of PCA3 and TMPRSS2-ERG in urine and PSA in serum following prostatic massage, by RNA amplification and fluorescence- based detection, algorithm reported as risk score ONC PRST8 PCA3&TMPRSS2- ERG
0114U Gastroenterology (Barrett’s esophagus), VIM and CCNA1 methylation analysis, esophageal cells, algorithm reported as likelihood for Barrett’s esophagus GI BARRETTS ESOPH VIM
0115U Respiratory infectious agent detection by nucleic acid (DNA and RNA), 18 viral types and subtypes and 2 bacterial targets, amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected RESPIR IADNA 18 VIRAL&2 BACT
0116U Prescription drug monitoring, enzyme immunoassay of 35 or more drugs confirmed with LC-MS/MS, oral fluid, algorithm results reported as a patient- compliance measurement with risk of drug to drug interactions for prescribed medications RX MNTR NZM IA 35+ORAL FLU
0117U Pain management, analysis of 11 endogenous analytes (methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5- hydroxyindoleacetic acid, hydroxymethylglutarate, ethylmalonate, 3- hydroxypropyl mercapturic acid (3- HPMA), quinolinic acid, kynurenic acid), LC- MS/MS, urine, algorithm reported as a pain-index score with likelihood of atypical biochemical function associated with pain PAIN MGMT 11 ENDOGENOUS ANAL
0118U Transplantation medicine, quantification of donor derived cell-free DNA using whole genome next generation sequencing, plasma, reported as percentage of donor- derived cell-free DNA in the total cell-free DNA TRNSPLJ DON-DRV CLL-FR DNA
0119U Cardiology, ceramides by liquid chromatography– tandem mass spectrometry, plasma, quantitative report with risk score for major cardiovascular events CRD CERAMIDES LIQ CHROM PLSM
0120U Oncology (B-cell lymphoma classification), mRNA, gene expression profiling by fluorescent probe hybridization of 58 genes (45 content and 13 housekeeping genes), formalin-fixed paraffinembedded tissue, algorithm reported as likelihood for primary mediastinal B-cell lymphoma (PMBCL) and diffuse large B-cell lymphoma (DLBCL) with cell of origin subtyping in the latter ONC B CLL LYMPHM MRNA 58 GEN
0121U Sickle cell disease, microfluidic flow adhesion (VCAM1), whole blood SC DIS VCAM-1 WHOLE BLOOD
0122U Sickle cell disease, microfluidic flow adhesion (PSelectin), whole blood SC DIS P-SELECTIN WHL BLOOD
0123U Mechanical fragility, RBC, shear stress and spectral analysis profiling MCHNL FRAGILITY RBC PRFLG
0124U Fetal congenital abnormalities, biochemical assays of 3 analytes (free beta-hCG, PAPP-A, AFP), time-resolved fluorescence immunoassay, maternal dried-blood spot, algorithm reported as risk scores for fetal trisomies 13/18 and 21 FTL CGEN ABNOR 3 ANALYTES
0125U Fetal congenital abnormalities and perinatal complications, biochemical assays of 5 analytes (free beta-hCG, PAPP-A, AFP, placental growth factor, and inhibin-A), time-resolved fluorescence immunoassay, maternal serum, algorithm reported as risk scores for fetal trisomies 13/18, 21, and preeclampsia FTL CGEN ABNOR PRNT COMP 5
0126U Fetal congenital abnormalities and perinatal complications, biochemical assays of 5 analytes (free beta-hCG, PAPP-A, AFP, placental growth factor, and inhibin-A), time-resolved fluorescence immunoassay, includes qualitative assessment of Y chromosome in cell-free fetal DNA, maternal serum and plasma, predictive algorithm reported as a risk scores for fetal trisomies 13/18, 21, and preeclampsia FTL CGEN ABNOR PRNT COMP 5 Y
0127U Obstetrics (preeclampsia), biochemical assays of 3 analytes (PAPP-A, AFP, and placental growth factor), time-resolved fluorescence immunoassay, maternal serum, predictive algorithm reported as a risk score for preeclampsia OB PE 3 ANALYTES
0128U Obstetrics (preeclampsia), biochemical assays of 3 analytes (PAPP-A, AFP, and placental growth factor), time-resolved fluorescence immunoassay, includes qualitative assessment of Y chromosome in cell-free fetal DNA, maternal serum and plasma, predictive algorithm reported as a risk score for preeclampsia OB PE 3 ANALYTES Y CHRMSM
0129U Hereditary breast cancer–related disorders (eg., hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis and deletion/duplication analysis panel (ATM, BRCA1, BRCA2, CDH1, CHEK2, PALB2, PTEN, and TP53) HERED BRST CA RLTD DO PANEL
0130U Hereditary colon cancer disorders ( eg., Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis), targeted RNA sequence analysis panel (APC, CDH1, CHEK2, MLH1, MSH2, MSH6, MUTYH, PMS2, PTEN, and TP53) HERED COLON CA DO MRNA PNL
0131U Hereditary breast cancer–related disorders ( eg., hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), targeted mRNA sequence analysis panel (13 genes) HERED BRST CA RLTD DO PNL 13
0132U Hereditary ovarian cancer–related disorders ( eg., hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), targeted mRNA sequence analysis panel (17 genes) HERED OVA CA RLTD DO PNL 17
0133U Hereditary prostate cancer–related disorders, targeted mRNA sequence analysis panel (11 genes) HERED PRST8 CA RLTD DO 11
0134U Hereditary pan cancer ( eg., hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer), targeted mRNA sequence analysis panel (18 genes) HERED PAN CA MRNA PNL 18 GEN
0135U Hereditary gynecological cancer ( eg., hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer), targeted mRNA sequence analysis panel (12 genes) HERED GYN CA MRNA PNL 12 GEN
0136U ATM (ataxia telangiectasia mutated) ( eg., ataxia telangiectasia) mRNA sequence analysis ATM MRNA SEQ ALYS
0137U PALB2 (partner and localizer of BRCA2) ( eg., breast and pancreatic cancer) mRNA sequence analysis PALB2 MRNA SEQ ALYS
0138U BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) ( eg., hereditary breast and ovarian cancer) mRNA sequence analysis BRCA1 BRCA2 MRNA SEQ ALYS
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