13 New Laboratory Codes – Updates & Changes By CMS

Clinical diagnostic laboratories can look forward to 12 new laboratory codes were effective April 1 and one code effective retroactively January 1. The Centers for Medicare and Medicate Services (CMS) released the changes May 5, 2018.

The new codes are contractor priced until addressed at the annual Clinical Laboratory Public Meeting in July. All the U codes will have HCPCS Pricing Indication code 22, which means the price is established by Medicare Administrative Contractors (MACS. instead of being subject to the National Limitation Amount.

Laboratory Codes Effective April 1, 2018

    0035U
        TOS 5
Short Descriptor—Neuro csf prion prtn qual;
Long Descriptor—Neurology (prion disease), cerebrospinal fluid, detection of prion protein by
quaking-induced conformational conversion, qualitative

    0036U
        TOS 5
Short Descriptor—Xome tum & nml spec seq alys;
Long Descriptor— Exome (ie, somatic mutations), paired formalin-fixed paraffin-embedded tumor
tissue and normal specimen, sequence analyses

    0037U
        TOS 5
Short Descriptor—Trgt gen seq dna 324 genes;
Long Descriptor— Targeted genomic sequence analysis, solid organ neoplasm, DNA analysis of 324
genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements,
microsatellite instability and tumor mutational burden

    0038U
        TOS 5
Short Descriptor—Vitamin d srm microsamp quan;
Long Descriptor— Vitamin D, 25 hydroxy D2 and D3, by LC-MS/MS, serum microsample,
quantitative

    0039U
        TOS 5
Short Descriptor—Dna antb 2strand hi avidity;
Long Descriptor— Deoxyribonucleic acid (DNA) antibody, double stranded, high avidity

    0040U
        TOS 5
Short Descriptor—Bcr/abl1 gene major bp quan;
Long Descriptor— BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis,
major breakpoint, quantitative

    0041U
        TOS 5
Short Descriptor—B brgdrferi antb 5 prtn igm;
Long Descriptor—Borrelia burgdorferi, antibody detection of 5 recombinant protein groups, by
immunoblot, IgM

    0042U
        TOS 5
Short Descriptor—B brgdrferi antb 12 prtn igg;
Long Descriptor—Borrelia burgdorferi, antibody detection of 12 recombinant protein groups, by
immunoblot, Ig

    0043U
        TOS 5
Short Descriptor—Tbrf b grp antb 4 prtn igm;
Long Descriptor—Tick- borne relapsing fever Borrelia group, antibody detection to 4 recombinant
protein groups, by immunoblot, IgM

    0044U
        TOS 5
Short Descriptor—Tbrf b grp antb 4 prtn igg;
Long Descriptor—Tick-borne relapsing fever Borrelia group, antibody detection to 4 recombinant
protein groups, by immunoblot, IgG0024U Glycosylated acute phase proteins (GlycA), nuclear
magnetic resonance spectroscopy, quantitative

    0012M
        TOS 5
Short Descriptor—Onc mrna 5 gen rsk urthl ca;
Long Descriptor— Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative
PCR of five genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and XCR2), utilizing urine, algorithm
reported as a risk score for having urothelial carcinoma

    0013M
        TOS 5
Short Descriptor—Onc mrna 5 gen recr urthl ca;
Long Descriptor— Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative
PCR of five genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and CXCR2), utilizing urine, algorithm
reported as a risk score for having recurrent urothelial carcinoma

 Laboratory Codes Effective January 1, 2018

And this code became effective January 1:
    0011M
        TOS 5
Short Descriptor—Onc prst8 ca mrna 12 gen alg;
Long Descriptor— Oncology, prostate cancer, mRNA expression assay of 12 genes (10 content and 2
housekeeping), RT-PCR test utilizing blood plasma and/or urine, algorithms to predict high-grade
prostate cancer risk

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