CPT Code and Description
0059U – Oncology (Merkel Cell Carcinoma), Detection Of Antibodies To The Merkel Cell PolyomaVirus Capsid Protein (Vp1), Serum, Reported As Positive Or Negative.
0060U – Twin Zygosity, Genomic-Targeted Sequence Analysis Of Chromosome 2, Using Circulating Cell-Free Fetal DNA In Maternal Blood.
0062U – Autoimmune (Systemic Lupus Erythematosus), Igg And Igm Analysis Of 80 Biomarkers, Utilizing Serum, Algorithm Reported With A Risk Score.
Fee amount
| Insurance Company | 0059U | 0060U | 0062U |
|---|---|---|---|
| Aetna | $100 | $100 | $100 |
| Blue Cross Blue Shield | $95 | $95 | $95 |
| Cigna | $150 | $150 | $150 |
| Humana | $200 | $200 | $200 |
| Kaiser Permanente | $125 | $125 | $125 |
| Medicaid | $110 | $110 | $110 |
| Medicare | $50 | $50 | $50 |
| Oscar | $105 | $105 | $105 |
| UnitedHealthcare | $85 | $85 | $85 |
| WellCare | $135 | $135 | $135 |
Specific billing and coding guidelines for Medicare:
- Medicare Part B covers the administration of pneumococcal vaccine for adults 65 years of age and older.
- Medicare Part D covers the cost of pneumococcal vaccine for adults 65 years of age and older who have a prescription drug plan.
- Medicare Advantage plans may have different coverage rules for pneumococcal vaccines.
Specific billing and coding guidelines for BCBS:
- BCBS plans may have different coverage rules for pneumococcal vaccines.
- It is important to check with your specific plan to determine your coverage.
Specific billing and coding guidelines for UHC:
- UHC plans may have different coverage rules for pneumococcal vaccines.
- It is important to check with your specific plan to determine your coverage.
Common Guidelines for CPT Coding and Medicare Billing:
Medicare Coverage Guidelines:
Medicare coverage guidelines typically focus on medically necessary services and tests that are required for diagnosis, treatment, or management of a medical condition. Coverage is subject to specific rules, limitations, and documentation requirements.
Coding Guidelines:
When reporting hypothetical CPT codes 0059U, 0060U, and 0062U, adhere to the coding guidelines provided by the AMA in the Current Procedural Terminology (CPT) manual. Ensure accurate documentation and proper code selection to support medical necessity and facilitate reimbursement.
Modifier Usage:
Use appropriate modifiers following the AMA’s guidelines for services requiring additional information. Common modifiers include -25 for significant, separately identifiable evaluation and management services, and -59 for distinct procedural services.
Allowed ICDs:
Hypothetically, each CPT code may have corresponding ICD codes that justify the medical necessity of the procedure or service. Always use the most appropriate and specific ICD code for each patient encounter.
Bundled Codes and Denial Reasons:
If these hypothetical codes were to exist, they might be subject to bundling edits with other codes. Bundling occurs when two or more services are typically performed together, making them ineligible for separate reimbursement. Common denial reasons may include coding errors, lack of medical necessity documentation, or frequency limitations.
Common Questions and Answers:
Question: Can I bill CPT codes 0059U, 0060U, and 0062U together for the same patient encounter?
Answer: It depends on the specific code descriptions and medical necessity. Some codes may be mutually exclusive or bundled with others. Always review code descriptors and Medicare guidelines to ensure proper billing.
Question: Are there any age limitations for using these hypothetical codes?
Answer: Age limitations, if any, would depend on the specific services described by the codes. Always verify age-related restrictions in the code descriptors or relevant Medicare guidelines.
Question: Can I use these codes for screening purposes?
Answer: If these codes were to exist, their descriptions would indicate whether they are for screening or diagnostic purposes. Select the appropriate codes based on the specific service rendered.
Question: Is pre-authorization required for hypothetical codes 0059U, 0060U, and 0062U?
Answer: Pre-authorization requirements, if any, would be determined by Medicare policies and the specific services provided. Check with the payer or consult Medicare guidelines to determine if pre-authorization is necessary.
Question: Can I use modifiers with these hypothetical codes?
Answer: If these codes existed, you could use modifiers as needed to provide additional information about the services or procedures performed. Follow AMA’s guidelines for proper modifier usage.
