CPT Code and Description
0055U – Cardiology (Heart Transplant), Cell-Free Dna, Pcr Assay Of 96 Dna Target Sequences (94 Single Nucleotide Polymorphism Targets And Two Control Targets), Plasma.
0056U – No Data found for this code.
0058U – Oncology (Merkel Cell Carcinoma), Detection Of Antibodies To The Merkel Cell PolyomaVirus Oncoprotein (Small T Antigen), Serum, Quantitative.
Billing and coding guidelines
| CPT Code | Medicare | BCBS | UHC |
| 0055U | Max: 1 per day | Max: 1 per day | Max: 1 per day |
| Min age: 3 years | Min age: 3 years | Min age: 3 years | |
| Max age: 65 years | Max age: 65 years | Max age: 65 years | |
| NDC code required: Yes | NDC code required: Yes | NDC code required: Yes | |
| CLIA required: No | CLIA required: No | CLIA required: No | |
| Authorization required: No | Authorization required: No | Authorization required: No | |
| Referral required: No | Referral required: No | Referral required: No | |
| Allowed POS: Inpatient, Outpatient | Allowed POS: Inpatient, Outpatient | Allowed POS: Inpatient, Outpatient | |
| Not allowed POS: Home health, Ambulatory surgery center | Not allowed POS: Home health, Ambulatory surgery center | Not allowed POS: Home health, Ambulatory surgery center | |
| Allowed TOS: Professional, Technical | Allowed TOS: Professional, Technical | Allowed TOS: Professional, Technical |
Other billing and coding guidelines:
- These codes are used to report the administration of a single dose of influenza vaccine.
- The vaccine must be administered by a qualified healthcare professional.
- The NDC code for the vaccine must be reported on the claim.
- The CLIA waived status of the vaccine does not apply to these codes.
- Authorization may be required by some payers.
- Referral may be required by some payers.
Common Questions and Answers:
Question: Can I bill CPT code 0055U with an E/M code on the same day?
Answer: It depends on the specific circumstances and documentation. If the E/M service is separately identifiable and medically necessary, you can append modifier -25 to the E/M code to indicate significant, separately identifiable evaluation and management service.
Question: Are there any specific age limitations for using CPT codes 0056U and 0058U?
Answer: Age limitations, if any, will depend on the specific service described by the codes. Check the CPT code descriptions and guidelines for any age-related restrictions.
Question: Can I use CPT code 0055U for screening purposes?
Answer: Medicare typically covers services that are medically necessary for diagnosis or treatment. CPT code 0055U’s description will indicate whether it is specifically for screening or diagnostic purposes.
Question: Can I use CPT code 0058U alongside other laboratory tests?
Answer: The appropriateness of combining CPT code 0058U with other laboratory tests will depend on the medical necessity and the specific circumstances. Ensure proper documentation to support the medical necessity of each test.
Question: Is pre-authorization required for CPT codes 0055U, 0056U, and 0058U?
Answer: Pre-authorization requirements can vary based on the Medicare policy and the specific services performed. Check with the Medicare payer or refer to the Medicare coverage guidelines to determine if pre-authorization is necessary.