CPT Code and Description
0197U – Red Cell Antigen (Landsteiner-Wiener Blood Group) Genotyping (Lw), Gene Analysis, Icam4 (Intercellular Adhesion Molecule 4 [Landsteiner-Wiener Blood Group]) Exon 1.
0198U – Red Cell Antigen (Rh Blood Group) Genotyping (Rhd And Rhce), Gene Analysis Sanger/Chain Termination/Conventional Sequencing, Rhd (Rh Blood Group D Antigen) Exons 1-10 And Rhce (Rh Blood Group Ccee Antigens) Exon 5.
0199U – Red Cell Antigen (Scianna Blood Group) Genotyping (Sc), Gene Analysis, Ermap (Erythroblast Membrane Associated Protein [Scianna Blood Group]) Exons 4, 12.
CPT code 0197U
- Medicare:
- Max units: 10
- Minimum age: 18
- Maximum age: 65
- NDC code required: Yes
- CLIA required: No
- Authorization required: No
- Referral required: No
- Allowed POS: Inpatient, Outpatient
- Not allowed POS: Not applicable
- Allowed TOS: Initial, Subsequent
- BCBS:
- Max units: 10
- Minimum age: 18
- Maximum age: 65
- NDC code required: Yes
- CLIA required: No
- Authorization required: No
- Referral required: No
- Allowed POS: Inpatient, Outpatient
- Not allowed POS: Not applicable
- Allowed TOS: Initial, Subsequent
- Other billing and coding guidelines:
- This code is used to report the administration of an influenza vaccine to an individual who is 18 years of age or older.
- The vaccine must be administered by a qualified healthcare professional.
- The NDC code for the vaccine must be included on the claim
Medicare Appeal and previous examples
0197U: Navigator LW Sequencing, Grifols Immunohematology Center
Public Comment
- Final recommendation: crosswalk to CPT 81403
- 1x multiplier for each
- Recommend NLA for 0197U: $185.20
Rationale
0197U reports the analysis of LW exon 1 using Sanger sequencing.
This procedure fits the descriptor and an example for CPT 81403 “Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons)” ~ AMA Submitted by Joel de Jesus, Mirepoix LLC on behalf of Grifols Immunohematology Center
0198U Red cell antigen (RH blood group) genotyping (RHD and RHCE), gene analysis Sanger/chain termination/conventional sequencing, RHD (Rh blood group D antigen) exons 1-10 and
RHCE (Rh blood group CcEe antigens) exon 5 Submitted by Joel de Jesus, Mirepoix LLC on behalf of Grifols Immunohematology Center
0198U: Navigator RHD/CE Sequencing, Grifols Immunohematology Center Public Comment
- Final recommendation: crosswalk to CPT 81406
- 1x multiplier for each
- Recommend NLA for 0198U: $282.88
Rationale
0198U reports the analysis of RHD exons 1 to 10 and RHCE exon 5 using Sanger sequencing. This procedure fits the descriptor and an example for CPT 81406 ““Molecular pathology procedure, Level 7, (e.g., analysis of 11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons, cytogenomic array analysis for neoplasia)” ~AMA