CPT Codes 0185U, 0186U, 0187U
CPT Code and Description
0185U – Red Cell Antigen (H Blood Group) Genotyping (Fut1), Gene Analysis, Fut1 (Fucosyltransferase 1 [H Blood Group]) Exon 4.
0186U – Red Cell Antigen (H Blood Group) Genotyping (Fut2), Gene Analysis, Fut2 (Fucosyltransferase 2) Exon 2.
0187U – Red Cell Antigen (Duffy Blood Group) Genotyping (Fy), Gene Analysis, Ackr1 (Atypical Chemokine Receptor 1 [Duffy Blood Group]) Exons 1-2.
Medicare and BCBS Guideliens
Medicare
- Max units: 1 per day
- Minimum age: 18 years old
- Maximum age: 99 years old
- NDC code required: Yes
- CLIA required: No
- Authorization required: No
- Referral required: No
- Allowed POS: Inpatient, Outpatient
- Not allowed POS: Home health, Hospice
- Allowed TOS: Hospital, ASC, Office
BCBS
- Max units: 1 per day
- Minimum age: 18 years old
- Maximum age: 99 years old
- NDC code required: Yes
- CLIA required: No
- Authorization required: No
- Referral required: No
- Allowed POS: Inpatient, Outpatient
- Not allowed POS: Home health, Hospice
- Allowed TOS: Hospital, ASC, Office
Referring Provider
Providers may only bill for laboratory services that are ordered by a physician or other qualified
practitioner. The name of the referring (ordering) provider must be included on all claim
transactions, or the services may deny. Refer to Lab Path Services – 005 Laboratory General
Guide
Clinical Laboratory Improvement Amendments (CLIA) Number Requirements
The CLIA number must be submitted on all 837P transactions for laboratory services billed by
any provider performing tests covered by CLIA. Claims submitted by providers for clinical
laboratory services covered under CLIA without a valid and current CLIA certificate may be
denied.
Lab Billed through the BlueCard Program
Blue Cross may contract with providers outside of their exclusive service area for services
provided to local and BlueCard members within their own service area for independent clinical
lab services. Providers who perform lab services should file the claim to the Blue plan where the
referring physician is located. The claim will be adjudicated based on the provider’s participation
status with that Blue plan.
Documentation Submission
Documentation must identify and describe the services performed. If a denial is appealed, this
documentation must be submitted with the appeal.
Coverage
Eligible services will be subject to the subscriber benefits, Blue Cross fee schedule amount and
any coding edits.
The following applies to all claim submissions.
All coding and reimbursement is subject to all terms of the Provider Service Agreement and
subject to changes, updates, or other requirements of coding rules and guidelines. All codes are
subject to federal HIPAA rules, and in the case of medical code sets (HCPCS, CPT, ICD), only
codes valid for the date of service may be submitted or accepted. Reimbursement for all Health
Services is subject to current Blue Cross Medical Policy criteria, policies found in the Provider
Policy and Procedure Manual sections, Reimbursement Policies and all other provisions of the
Provider Service Agreement (Agreement).
In the event that any new codes are developed during the course of Provider’s Agreement, such
new codes will be paid according to the standard or applicable Blue Cross fee schedule until
such time as a new agreement is reached and supersedes the Provider’s current Agreement.
All payment for codes based on Relative Value Units (RVU) will include a site of service
differential and will be calculated using the appropriate facility or non-facility components, based
on the site of service identified, as submitted by Provider.