Medicare Reimbursement: CMS Publishes New CPT Codes
From - National Intelligence Report 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… . . . read more
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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