CPT Changes in April 2022 & July 2022

New CPT Codes Included Effective From April 1st, 2022

CPT Description

0306U Oncology (minimal residual disease [MRD]), next-generation targeted sequencing analysis, cell-free DNA, initial (baseline) assessment to determine a patient specific panel for future comparisons to evaluate for MRD

0307U Oncology (minimal residual disease [MRD]), next-generation targeted sequencing analysis of a patient-specific panel, cell-free DNA, subsequent assessment with comparison to previously analyzed patient specimens to evaluate for MRD

0308U Cardiology (coronary artery disease [CAD]), analysis of 3 proteins (high sensitivity [hs] troponin, adiponectin, and kidney injury molecule-1 [KIM-1]), plasma, algorithm reported as a risk score for obstructive CAD

0309U Cardiology (cardiovascular disease), analysis of 4 proteins (NT-proBNP, osteopontin, tissue inhibitor of metalloproteinase-1 [TIMP-1], and kidney injury molecule-1 [KIM-1]), plasma, algorithm reported as a risk score for major adverse cardiac event

0310U Pediatrics (vasculitis, Kawasaki disease [KD]), analysis of 3 biomarkers (NTproBNP, C-reactive protein, and T-uptake), plasma, algorithm reported as a risk score for KD

0311U Infectious disease (bacterial), quantitative antimicrobial susceptibility reported as phenotypic minimum inhibitory concentration (MIC)–based antimicrobial susceptibility for each organisms identified

0312U Autoimmune diseases (eg, systemic lupus erythematosus [SLE]), analysis of 8 IgG autoantibodies and 2 cell-bound complement activation products using enzyme-linked immunosorbent immunoassay (ELISA), flow cytometry and indirect immunofluorescence, serum, or plasma and whole blood, individual components reported along with an algorithmic SLE-likelihood assessment

0313U Oncology (pancreas), DNA and mRNA next-generation sequencing analysis of 74 genes and analysis of CEA (CEACAM5) gene expression, pancreatic cyst fluid, algorithm reported as a categorical result (ie, negative, low probability of neoplasia or positive, high probability of neoplasia)

0314U Oncology (cutaneous melanoma), mRNA gene expression profiling by RT-PCR of 35 genes (32 content and 3 housekeeping), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a categorical result (ie, benign, intermediate, malignant)

0315U Oncology (cutaneous squamous cell carcinoma), mRNA gene expression profiling by RT-PCR of 40 genes (34 content and 6 housekeeping), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a categorical risk result (ie, Class 1, Class 2A, Class 2B)

0316U Borrelia burgdorferi (Lyme disease), OspA protein evaluation, urine

0317U Oncology (lung cancer), four-probe FISH (3q29, 3p22.1, 10q22.3, 10cen) assay, whole blood, predictive algorithmgenerated evaluation reported as decreased or increased risk for lung cancer

0318U Pediatrics (congenital epigenetic disorders), whole genome methylation analysis by microarray for 50 or more genes, blood

0319U Nephrology (renal transplant), RNA expression by select transcriptome sequencing, using pretransplant peripheral blood, algorithm reported as a risk score for early acute rejection

0320U Nephrology (renal transplant), RNA expression by select transcriptome sequencing, using posttransplant peripheral blood, algorithm reported as a risk score for acute cellular rejection

0321U Infectious agent detection by nucleic acid (DNA or RNA), genitourinary pathogens, identification of 20 bacterial and fungal organisms and identification of 16 associated antibiotic-resistance genes, multiplex amplified probe technique

0322U Neurology (autism spectrum disorder [ASD]), quantitative measurements of 14 acyl carnitines and microbiome-derived metabolites, liquid chromatography with tandem mass spectrometry (LC-MS/MS), plasma, results reported as negative or positive for risk of metabolic subtypes associated with ASD

New CPT Codes Included Effective From July 1st, 2022

0714T Transperineal Laser Ablation Of Benign Prostatic Hyperplasia, Including Imaging Guidance

0715T Percutaneous Transluminal Coronary Lithotripsy (List Separately In Addition To Code For Primary Procedure)

0716T Cardiac Acoustic Waveform Recording With Automated Analysis And Generation Of Coronary Artery Disease Risk Score

0717T Autologous Adipose-Derived Regenerative Cell (Adrc) Therapy For Partial Thickness Rotator Cuff Tear; Adipose Tissue Harvesting, Isolation And Preparation Of Harvested Cells, Including Incubation With Cell Dissociation Enzymes, Filtration, Washing And Concentration Of Adrcs

0718T Autologous Adipose-Derived Regenerative Cell (Adrc) Therapy For Partial Thickness Rotator Cuff Tear; Injection Into Supraspinatus Tendon Including Ultrasound Guidance, Unilateral

0719T Posterior Vertebral Joint Replacement, Including Bilateral Facetectomy, Laminectomy, And Radical Discectomy, Including Imaging Guidance, Lumbar Spine, Single Segment

0720T Percutaneous Electrical Nerve Field Stimulation, Cranial Nerves, Without Implantation

0721T Quantitative Computed Tomography (Ct) Tissue Characterization, Including Interpretation And Report, Obtained Without Concurrent Ct Examination Of Any Structure Contained In Previously Acquired Diagnostic Imaging

0722T Quantitative Computed Tomography (Ct) Tissue Characterization, Including Interpretation And Report, Obtained With Concurrent Ct Examination Of Anystructure Contained In The Concurrently Acquired Diagnostic Imaging Dataset (List Separately In Addition To Code For Primary Procedure)

0723T Quantitative Magnetic Resonance Cholangiopancreatography (Qmrcp) Including Data Preparation And Transmission, Interpretation And Report, Obtained Without Diagnostic Magnetic Resonance Imaging (Mri) Examination Of The Same Anatomy (Eg, Organ, Gland, Tissue, Target Structure) During The Same Session

0724T Quantitative Magnetic Resonance Cholangiopancreatography (Qmrcp) Including Data Preparation And Transmission, Interpretation And Report, Obtained With Diagnostic Magnetic Resonance Imaging (Mri) Examination Of The Same Anatomy (Eg, Organ, Gland, Tissue, Target Structure) (List Separately In Addition To Code For Primary Procedure)

0725T Vestibular Device Implantation, Unilateral

0726T Removal Of Implanted Vestibular Device, Unilateral

0727T Removal And Replacement Of Implanted Vestibular Device, Unilateral

0728T Diagnostic Analysis Of Vestibular Implant, Unilateral; With Initial Programming

0729T Diagnostic Analysis Of Vestibular Implant, Unilateral; With Subsequent Programming

0730T Trabeculotomy By Laser, Including Optical Coherence Tomography (Oct) Guidance

0731T Augmentative Ai-Based Facial Phenotype Analysis With Report

0732T Immunotherapy Administration With Electroporation, Intramuscular

0733T Remote Body And Limb Kinematic Measurement-Based Therapy Ordered By A Physician Or Other Qualified Health Care Professional; Supply And Technical Support, Per 30 Days

0734T Remote Body And Limb Kinematic Measurement-Based Therapy Ordered By A Physician Or Other Qualified Health Care Professional; Treatment Management Services By A Physician Or Other Qualified Health Care Professional, Per Calendar Month

0735T Preparation Of Tumor Cavity, With Placement Of A Radiation Therapy Applicator For Intraoperative Radiation Therapy (Iort) Concurrent With Primary Craniotomy (List Separately In Addition To Code For Primary Procedure)

0736T Colonic Lavage, 35 Or More Liters Of Water, Gravity-Fed, With Induced Defecation, Including Insertion Of Rectal Catheter

0737T Xenograft Implantation Into The Articular Surface

90584 Dengue Vaccine, Quadrivalent, Live, 2 Dose Schedule, For Subcutaneous Use

Revised CPT Codes Effective From April 1st, 2022

CPT Description

0022U Targeted genomic sequence analysis panel, cholangiocarcinoma and non-small cell lung neoplasia, DNA and RNA analysis, 1-23 genes, interrogation for sequence variants and rearrangements, reported as presence/absence of variants and associated therapy(ies) to consider

Revised CPT Codes Effective From July 1st, 2022

0402T Collagen Cross-Linking Of Cornea, Including Removal Of The Corneal Epithelium, When Performed, And Intraoperative Pachymetry, When Performed

90739 Hepatitis B Vaccine (Hepb), Cpg-Adjuvanted, Adult Dosage, 2 Dose Or 4 Dose Schedule, For Intramuscular Use

Deleted CPT Codes Effective From April 1st, 2022

CPT Description

0097U Gastrointestinal pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 22 targets (Campylobacter [C. jejuni/C. coli/C. upsaliensis], Clostridium difficile [C. difficile] toxin A/B, Plesiomonas shigelloides, Salmonella, Vibrio [V.parahaemolyticus/V. vulnificus/V. cholerae], including specific identification of Vibrio cholerae, Yersinia enterocolitica, Enteroaggregative Escherichia coli [EAEC], Enteropathogenic Escherichia coli [EPEC], Enterotoxigenic Escherichia coli [ETEC] lt/st, Shigalike toxin-producing Escherichia coli [STEC] stx1/stx2 [including specific identification of the E. coli O157 serogroup within STEC], Shigella/Enteroinvasive Escherichia coli [EIEC], Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica, Giardia lamblia [also known as G. intestinalis and G. duodenalis], adenovirus F 40/41, astrovirus, norovirus GI/GII, rotavirus A, sapovirus [Genogroups I, II, IV, and V])

0151U Infectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 33 targets, real-time semi-quantitative PCR, bronchoalveolar lavage, sputum, or endotracheal aspirate, detection of 33 organismal and antibiotic resistance genes with limited semi-quantitative results.

 

Click here for related Updates

COVID-19 vaccine and Monoclonal Antibody Billing for Part B Providers

Guidelines for COVID-19 vaccines and monoclonal antibodies Billing

The patient can get the vaccines including of booster dose and or additional doses.

The patient administered the vaccine with no out of pocket cost for both vaccines and administration of the vaccines.

Vaccinate everyone, including the uninsured, regardless of coverage or network status.

When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, only bill for the vaccine administration. Don't include the vaccine codes on the claim when the vaccines are free.

If the patient is enrolled in a Medicare Advantage (MA) plan, submit your COVID-19 vaccine and monoclonal antibody infusion claims to Original Medicare in 2020 and 2021. On or after January 1, 2022, claims for vaccine or mAb administrations for Medicare Advantage enrolls should be submitted to the Medicare Advantage plan. 

For services provided to Medicare Advantage enrolls on or after January 1, 2022, contact the Medicare Advantage for guidance on coverage and billing.

Code Description   Vaccine Name Effective date

91300* SARSCOV2 VAC 30MCG/0.3ML IM Pfizer 12/11/2020

0001A ADM SARSCOV2 30MCG/0.3ML 1ST Pfizer 12/11/2020

0002A ADM SARSCOV2 30MCG/0.3ML 2ND Pfizer 12/11/2020

0003A ADM SARSCOV2 30MCG/0.3ML 3RD Pfizer 08/12/2021

0004A ADM SARSCOV2 30MCG/0.3ML BST Pfizer 09/22/2021

91301* SARSCOV2 VAC 100MCG/0.5ML IM Moderna 12/18/2020

0011A ADM SARSCOV2 100MCG/0.5ML1ST Moderna 12/18/2020

0012A ADM SARSCOV2 100MCG/0.5ML2ND Moderna 12/18/2020

0013A ADM SARSCOV2 100MCG/0.5ML3RD Moderna 08/12/2021

91303* SARSCOV2 VAC AD26 .5ML IM Janssen 02/27/2021

0031A ADM SARSCOV2 VAC AD26 .5ML Janssen 02/27/2021

0034A ADM SARSCOV2 VAC AD26 .5ML B Janssen 10/20/2021

91305* SARSCOV2 VAC 30 MCG TRS-SUCR Pfizer 01/03/2022

0051A ADM SARSCV2 30MCG TRS-SUCR 1 Pfizer 01/03/2022

0052A ADM SARSCV2 30MCG TRS-SUCR 2 Pfizer 01/03/2022

0053A ADM SARSCV2 30MCG TRS-SUCR 3 Pfizer 01/03/2022

0054A ADM SARSCV2 30MCG TRS-SUCR B Pfizer 01/03/2022

91306* SARSCOV2 VAC 50MCG/0.25ML IM Moderna 10/20/2021

0064A ADM SARSCOV2 50MCG/0.25MLBST Moderna 10/20/2021

91307* SARSCOV2 VAC 10 MCG TRS-SUCR Pfizer 10/29/2021

0071A ADM SARSCV2 10MCG TRS-SUCR 1 Pfizer 10/29/2021

0072A ADM SARSCV2 10MCG TRS-SUCR 2 Pfizer 10/29/2021

0073A ADM SARSCV2 10MCG TRS-SUCR 3 Pfizer 01/03/2022

M0201** COVID-19 vaccine home admin N/A 06/08/2021

**Providers should not bill for the product if they received it for free.

**The services are covered only in places of service 04, 06, 09, 12, 13, 14, 16, 19, 22, 33, 54, 55, 56, and 60

Monoclonal antibodies and administration

Code Description             Effective date

Q0220* Tixagev and cilgav, 300mg 12/08/2021

Q0221* Tixagev and cilgav, 600mg 02/24/2022

M0220 Tixagev and cilgav inj 12/08/2021

M0221 Tixagev and cilgav inj hm 12/08/2021

Q0222* Bebtelovimab 175 mg 02/11/2022

M0222 Bebtelovimab injection 02/11/2022

M0223 Bebtelovimab injection home 02/11/2022

Q0239* bamlanivimab-xxxx 11/10/2020 – 04/16/2021

M0239 bamlanivimab-xxxx infusion 11/10/2020 – 04/16/2021

Q0240* Casirivi and imdevi 600mg 07/30/2021

M0240 Casiri and imdev repeat 07/30/2021

M0241 Casiri and imdev repeat hm 07/30/2021

Q0243* casirivimab and imdevimab 11/21/2020

M0243 Casirivi and imdevi inj 11/21/2020

Q0244* casirivi and imdevi 1200 mg 06/03/2021

M0244 Casirivi and imdevi inj hm 05/06/2021

Q0245* bamlanivimab and etesevima 02/09/2021

M0245 bamlan and etesev infusion 02/09/2021

M0246 bamlan and etesev infus home 05/06/2021

Q0247** sotrovimab 05/26/2021

M0247 sotrovimab infusion 05/26/2021

M0248 sotrovimab inf, home admin 05/26/2021

Q0249** Tocilizumab for COVID-19 06/24/2021

M0249 Adm Tocilizu COVID-19 1st 06/24/2021

M0250 Adm Tocilizu COVID-19 2nd 06/24/2021

Note:

• *Providers should not bill for the product if they received it for free.
• **The government won’t provide this drug for free.

Click here for COVID-19 CPT Codes