Posted 08/29/2024: Under CPT/HCPCS Codes Group 11: Paragraph added “Non-Urogenital/Anogenital Cutaneous/Mucocutaneous Lesion Panels: This code is reimbursed under limited circ*mstances”. Under CPT/HCPCS Codes Group 11: Codes added 87999. Under CPT/HCPCS Modifiers Group 11: Codes added 59. Under ICD-10 Codes that Support Medical Necessity Group 11: Paragraph added “These are the diagnosis codes corresponding to coverage of CPT/HCPCS Codes Group 11: Codes -Non-Urogenital/ Anogenital Cutaneous/ Mucocutaneous Lesion Panels”. Under ICD-10 Codes that Support Medical Necessity Group 11: Codes added B00.0, B00.1, B00.2, and B00.59. This revision is effective 03/28/2024.
Posted 08/01/2024: Under CPT/HCPCS Codes Group 5: Codes deleted 0353U and added 0455U. This is due to the 2024 Q3 CPT/HCPCS Code Update and is effective 7/1/2024.
Posted 04/25/2024 Under CPT/HCPCS Codes Group 9: Paragraph deleted “Arthropod” and replaced with “Zoonotic”. Under ICD-10 Codes that Support Medical Necessity Group 9: Paragraph deleted “Arthropod” and replaced with “Zoonotic”. This revision is effective 2/29/2024.
Posted 03/28/2024 Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted Z20.822 and Z20.828. The addition of these codes was done in error. This revision is effective for dates of service on or after 4/17/2022.
Posted 02/01/2024 Under CPT/HCPCS Group 8: Codes added 87523 and 0429U. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is effective 1/1/2024.
Under Article Text added “NOTE: When entering the DEX Z-Code® on the SV101-7 documentation field for Part B claims please do not add additional characters and/or information on the line”. This revision is effective 1/1/2024.
Posted 10/26/2023 Under Additional Information bullet point 7 updated “Palmetto” to “this contractor”.
Under CPT/HCPCS Group 5: Codes added 0402U. This revision is due to the 2023 Q4 CPT/HCPCS Code Update and is effective 10/1/2023.
Under CPT/HCPCS Codes Group 9: Paragraph added “Arthropod Infection Panels: This code is reimbursed under limited circ*mstances. Note also the additional diagnostic guidance provided by the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/ticks/tickbornediseases”. Under CPT/HCPCS Group 9: Codes added 87999. Under CPT/HCPCS Modifiers Group 9: Codes added 59. Under ICD-10 Codes that Support Medical Necessity Group 9: Paragraph added “These are the diagnosis codes corresponding to coverage of CPT/HCPCS Codes Group 9: Codes - Arthropod Infection Panels”. Under ICD-10 Codes that Support Medical Necessity Group 9: Codes added A77.40, A77.41, A77.49, A79.82, A79.9, A84.89, A84.9, A85.2, A85.8, A86, A93.8, A94, B60.00, B60.09, B60.01, B60.02, B60.03, G04.81, G04.90, R41.82, W57.XXXA, W57.XXXD, and W57.XXXS. This revision is effective 5/8/2023.
Under CPT/HCPCS Codes Group 10: Paragraph added “Joint Infection Panels: This code is reimbursed under limited circ*mstances”. Under CPT/HCPCS Group 10: Codes added 87999. Under CPT/HCPCS Modifiers Group 10: Codes added 59. Under ICD-10 Codes that Support Medical Necessity Group 10: Paragraph added “These are the diagnosis codes corresponding to coverage of CPT/HCPCS Codes Group 10: Codes - Joint Infection Panels”. Under ICD-10 Codes that Support Medical Necessity Group 10: Codes added A01.04, A02.23, A54.42, M00.00, M00.011, M00.012, M00.019, M00.021, M00.022, M00.029, M00.031, M00.032, M00.039, M00.041, M00.042, M00.049, M00.051, M00.052, M00.059, M00.061, M00.062, M00.069, M00.071, M00.072, M00.079, M00.08, M00.09, M00.10, M00.111,M00.112, M00.119, M00.121, M00.122, M00.129, M00.131, M00.132, M00.139, M00.141, M00.142, M00.149, M00.151, M00.152, M00.159, M00.161, M00.162, M00.169, M00.171, M00.172, M00.179, M00.18, M00.211, M00.212, M00.219, M00.221, M00.222, M00.229, M00.231, M00.232, M00.239, M00.241, M00.242, M00.249, M00.251, M00.252, M00.259, M00.261, M00.262, M00.269, M00.271, M00.272, M00.279, M00.28, M00.29, M00.80, M00.811, M00.812, M00.819, M00.821, M00.822, M00.829, M00.831, M00.832, M00.839, M00.841, M00.842, M00.849, M00.851, M00.852, M00.859, M00.861, M00.862, M00.869, M00.871, M00.872, M00.879, M00.88, M00.89, M00.9, M01.X0, M01.X11, M01.X12, M01.X19, M01.X21, M01.X22, M01.X29, M01.X31, M01.X32, M01.X39, M01.X41, M01.X42, M01.X49, M01.X51, M01.X52, M01.X59, M01.X61, M01.X62, M01.X69, M01.X71, M01.X72, M01.X79, M01.X8, M01.X9, T84.50XS, T84.50XA, T84.50XD, T84.51XA, T84.51XD, T84.51XS, T84.52XA, T84.52XD, T84.52XS, T84.53XA, T84.53XD, T84.53XS, T84.54XA, T84.54XD, T84.54XS, T84.59XA, T84.59XD, T84.59XS, T84.60XA, T84.60XD, T84.60XS, T84.610A, T84.610D, T84.610S, T84.611A, T84.611D, T84.611S, T84.612A, T84.612D, T84.612S, T84.613A, T84.613D, T84.613S, T84.614A, T84.614D, T84.614S, T84.615A, T84.615D, T84.615S, T84.619A, T84.619D, T84.619S, T84.620A, T84.620D, T84.620S, T84.621A, T84.621D, T84.621S, T84.622A, T84.622D, T84.622S, T84.623A, T84.623D, T84.623S, T84.624A, T84.624D, T84.624S, T84.625A, T84.625D, T84.625S, T84.629A, T84.629D, T84.629S, T84.63XA, T84.63XD, T84.63XS, T84.69XA, T84.69XD, T84.69XS, T84.7XXA, T84.7XXD, and T84.7XXS. This revision is effective 8/19/2022.
Posts 08/31/2023 Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added J15.61 and J15.69. Under ICD-10 Codes that Support Medical Necessity Group 2: Codes added K35.200, K35.201, K35.209, K35.210, K35.211, K35.219, K63.8211, K63.8212, K63.8219, K63.822, and K63.829. Under ICD-10 Codes that Support Medical Necessity Group 4: Codes added A41.54 and B96.83. Under ICD-10 Codes that Support Medical Necessity Group 6: Codes added J44.81 and J44.89. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/01/2023.
Under Article Text revised the 4th bullet 2nd sentence to add “and a TA. If an existing CPT® code does not identify the service, it requires the use of CPT® code 87999”. Deleted the 3rd and 4th sentences. Revised the 7th and 10th bullets to remove “DEX Z-Code™” and replaced with “DEX Z-Code®”. This revision is effective on 10/01/2023.
Posted 07/27/2023 Under CPT/HCPCS Codes Group 6: Codes added 87999. This revision is effective on 03/24/2023. Under CPT/HCPCS Group 8: Codes deleted U0003, U0004, and U0005. This revision is related to the end of the COVID-19 PHE and is effective for dates of service on or after 05/12/2023.
Posted 04/27/2023 Under CPT/HCPCS Codes Group 8: Codes added 87149, 87150, and 87153. Review completed 03/28/2023.
Posted 03/30/2023 Under CPT/HCPCS Codes Group 6: Paragraph revised 2nd sentence to add “Per policy, these”. Added last sentence (4) For testing in POS other than POS 19, 21, 22, or 23, to bill one of the Group 6 CPT codes, TWO ICD-10 codes are required-one from Group 6 and another from Group 1. Under CPT/HCPCS Codes Group 7: Paragraph revised 2nd sentence to add “Per policy, these”. Added last sentence (4) For testing in POS other than POS 19, 21, 22, or 23, to bill one of the Group 7 CPT codes, TWO ICD-10 codes are required-one from Group 7 and another from Group 2. Under ICD-10 Codes that Support Medical Necessity Group 5: Codes added B37.89 and R30.0. Deleted N93.9 and N95.0. This revision is retroactive effective for dates of service on or after 4/17/2022. Review completed 02/22/2023.
Posted 01/26/2023 Under CPT/HCPCS Codes Group 5: Codes the description was revised for 87999. Under CPT/HCPCS Codes Group 8: Codes added 87468, 87469, 87478, and 87484. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is effective on January 1, 2023.
Posted 12/29/2022 Under ICD-10 Codes that Support Medical Necessity Group 5: Codes added L29.2, L29.3, N90.89, N93.0, N93.8, N93.9, N95.0, R10.2, and Z20.2. This revision is retroactive effective for dates of service on or after 4/17/2022.
Posted 10/27/2022 Under Article Text revised the thirteenth bullet first sentence to add “for the same (or highly similar) intended use”. Under CPT/HCPCS Codes Group 5: Codes added 87999. This revision is retroactive effective for dates of service on or after 04/17/2022. Under CPT/HCPCS Codes Group 5: Codes added 0352U and 0353U. Under CPT/HCPCS Codes Group 8: Codes added 87593. This revision is due to the Q4 CPT/HCPCS Code Update and is effective for dates of service on or after 10/01/2022.
Posted 09/29/2022 Under ICD-10 Codes that Support Medical Necessity Group 6: Paragraph revised second sentence to add “POS 19, 21, 22 or 23”. Under ICD-10 Codes that Support Medical Necessity Group 7: Paragraph revised second sentence to add “POS 19, 21, 22 or 23”. This revision is retroactive effective for dates of service on or after 05/17/2022.
Under ICD-10 Codes that Support Medical Necessity Group 5: Paragraph added “NOTE: Claims with diagnosis code Z11.3 would be expected to also include a high-risk diagnosis code”. Under ICD-10 Codes that Support Medical Necessity Group 5: Codes added Z11.3, Z33.1, Z33.3, Z72.51, Z72.52, Z72.53, Z72.89. This revision is retroactive effective for dates of service on or after 09/06/2022.
Under ICD-10 Codes that Support Medical Necessity Group 2: Codes added D59.30 and D59.31. Under ICD-10 Codes that Support Medical Necessity Group 4: Codes added D59.30 and D59.31. Under ICD-10 Codes that Support Medical Necessity Group 5: Codes deleted B37.3. Added B37.31, B37.32, and N76.82. Under ICD-10 Codes that Support Medical Necessity Group 6: Codes added D81.82. Under ICD-10 Codes that Support Medical Necessity Group 7: Codes added D81.82. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/01/2022. Review completed 08/30/2022.
Posted 05/26/2022 Under CPT/HCPCS Codes Group 6: Codes deleted 0151U. Under CPT/HCPCS Codes Group 7: Codes deleted 0097U. This revision is due to the Q2 CPT/HCPCS Code Update and is effective for dates of service on or after 04/01/2022.
Under Article Text revised first and second bullet verbiage to add “or PLA” and deleted third and fourth bullet verbiage. Revised fifth bullet verbiage to add, “and a TA.” Deleted the sixth and seventh bullet verbiage. Added two new bullet verbiages, “Tests that are FDA-approved/cleared and performed in ways consistent with their intended-use labeling directions do not require a Z-code when billed with an appropriate accompanying ICD-10 code. However, the performance of multiple (>1) FDA-approved/cleared molecular Infectious Disease pathogen identification tests on the same date of service (DOS) for the same intended use on the same patient sample is considered as one distinct service. As such, it would require the use of CPT® code 87999. Tests using CPT® code 87999 will require a Z-code and a TA.” And “Add modifier 59 for different species or strains reported by the same code, as allowed by the policy.” Revised Additional Information nineth bullet verbiage to “Places of service (POS) 19, 21, 22, 23 OR” and “(for healthcare POS other than the POS listed in 1 a).” Under CPT/HCPCS Group 1: Paragraph deleted second sentence. Under CPT/HCPCS Codes Group 1: Codes added 87801. Under CPT/HCPCS Group 2: Paragraph deleted second sentence. Under CPT/HCPCS Group 3: Paragraph deleted second sentence. Under CPT/HCPCS Group 4: Paragraph deleted second sentence. Under CPT/HCPCS Group 5: Paragraph deleted second sentence. Under CPT/HCPCS Group 5: Codes deleted 87623, 87624, and 87625. Under CPT/HCPCS Group 6: Paragraph deleted third sentence. Revised fourth sentence to add “POS 19, 21, 22, 23” and “(for healthcare POS other than those listed in a).” Under CPT/HCPCS Group 6: Codes added 87801. Under CPT/HCPCS Group 7: Paragraph deleted third sentence. Revised fourth sentence to add “POS 19, 21, 22, 23” and “(for healthcare POS other than those listed in a).” Under CPT/HCPCS Group 8: Paragraph added verbiage, “Conditionally Non-covered CPT codes: The following CPT codes are NOT covered for a given beneficiary on the same DOS when >1 is billed in combination with another CPT or PLA code from Groups 1-7 for the same intended use. Additionally, the following CPT codes are NOT covered for a given beneficiary on the same DOS when >2 are billed for the same intended use.” Under CPT/HCPCS Group 8: Codes added U0001, U0002, U0003, U0004, U0005, 87471, 87472, 87475, 87476, 87480, 87481, 87482, 87485, 87486, 87487, 87490, 87491, 87492, 87493, 87495, 87496, 87497, 87498, 87501, 87502, 87503, 87510, 87511, 87512, 87516, 87517, 87520, 87521, 87522, 87525, 87526, 87527, 87528, 87529, 87530, 87531, 87532, 87533, 87534, 87535, 87536, 87537, 87538, 87539, 87540, 87541, 87542, 87550, 87551, 87552, 87555, 87556, 87557, 87560, 87561, 87562, 87563, 87580, 87581, 87582, 87590, 87591, 87592, 87623, 87624, 87625, 87634, 87635, 87640, 87641, 87650, 87651, 87652, 87653, 87660, 87661, 87662, 87797, 87798, and 87799. Under CPT/HCPCS Modifiers Group 8: Codes added 59. Under ICD-10 Codes that Support Medical Necessity Group 3: added B60.2, Group 5: added N76.89, N77.1, and N89.8. This revision is effective 05/17/2022.
Posted 04/14/2022 Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added A37.00, A37.01, A37.10, A37.11, A37.80, A37.81, A37.90, A37.91, A41.81, A41.89, A48.1, A48.2, B25.0, B33.23, B33.24, B59, J05.0, J12.0, J12.2, J12.3, J13, J15.0, J15.1, J15.20, J15.211, J15.212, J15.29, J15.3, J15.4, J15.7, J15.8, J15.9, J16.0, J20.0, J20.1, J20.2, J20.3, J20.4, J20.6, J22, J84.116, J84.117, J84.2, J85.0, J85.1, J85.2, J85.3, T86.33, and T86.812. Under ICD-10 Codes that Support Medical Necessity Group 2: Paragraph added the verbiage “Targeted”. Under ICD-10 Codes that Support Medical Necessity Group 2: Codes added A08.31, A08.32, A32.11, A32.12, A32.7, K51.414, K92.1, R10.11, R10.12, R10.13 and T86.852. Deleted B20, K50.018, K50.111, K50.818, K50.918, K51.018, K51.218, K51.318, K51.518, and K51.818. Under ICD-10 Codes that Support Medical Necessity Group 3: Codes added R41.82 and R50.9. Deleted B00.1. Under ICD-10 Codes that Support Medical Necessity Group 4: Codes deleted E10.69, E11.69, and E13.69. Under ICD-10 Codes that Support Medical Necessity Group 5: Codes added O98.711, O98.712, and O98.713. Under ICD-10 Codes that Support Medical Necessity Group 6: Paragraph added verbiage “For testing in POS other than POS 21 or 23” to beginning of second sentence and “(once per transplant)” to third sentence. Under ICD-10 Codes that Support Medical Necessity Group 6: Codes added E08.43, E10.43, E11.43, and E13.43. Deleted A37.00, A37.01, A37.10, A37.11, A37.80, A37.81, A37.90, A37.91, A41.81, A41.89, A41.9, A48.1, A48.2, B25.0, B25.1, B25.2, B25.8, B33.23, B33.24, B59, B97.21, B97.29, D80.7, J05.0, J12.0, J12.2, J12.3, J12.81, J12.82, J12.89, J12.9, J13, J15.0, J15.1, J15.20, J15.211, J15.212, J15.29, J15.3, J15.4, J15.7, J15.8, J15.9, J16.0, J16.8, J18.1, J20.0, J20.1, J20.2, J20.3, J20.4, J20.5, J20.6, J20.8, J20.9, J21.9, J22, J44.0, J44.1, J45.31, J45.32, J45.41, J45.42, J45.51, J45.52, J45.901, J45.902, J84.116, J84.117, J84.2, J85.0, J85.1, J85.2, J85.3, R65.20, R65.21, R78.81, T86.33, and T86.812. Under ICD-10 Codes that Support Medical Necessity Group 7: Paragraph added verbiage “For testing in POS other than POS 21 or 23” to beginning of second sentence and “(once per transplant)” to third sentence. Under ICD-10 Codes that Support Medical Necessity Group 7: Codes deleted A00.0, A00.1, A00.9, A01.00, A01.09, A01.1, A01.2, A01.3, A02.0, A02.1, A02.8, A03.0, A03.1, A03.2, A03.3, A03.8, A04.0, A04.1, A04.2, A04.3, A04.5, A04.6, A04.71, A04.72, A04.8, A04.9, A05.0, A05.1, A05.2, A05.3, A05.4, A05.5, A06.0, A06.1, A06.2, A07.1, A07.2, A07.4, A08.0, A08.11, A08.19, A08.2, A08.31, A08.32, A08.39, A08.8, A09, A32.11, A32.12, A32.7, A41.50, A41.51, A41.52, A41.53, A41.59, A41.81, A41.89, A41.9, B25.0, B25.8, D80.7, K50.014, K50.114, K50.814, K50.914. K51.014, K51.214, K51.314, K51.414, K51.514, K51.814, K51.914, K52.1, K56.0, K92.1, M31.19, R10.0, R10.11, R10.12, R10.13, R10.31, R10.32, R10.33, R10.811, R10.812, R10.813, R10.814, R10.815, R10.817, R10.821, R10.822, R10.823, R10.824, R10.825, R10.826, R10.827, R10.829, R10.84, R19.5, R19.7, R50.9, R65.20, R65.21, R78.81, and T86.852. Review completed 03/10/2022.
