CPT Code and Description
0007U – Drug Test(S), Presumptive, With Definitive Confirmation Of Positive Results, Any Number Of Drug Classes, Urine, Includes Specimen Verification Including Dna Authentication In Comparison To Buccal Dna, Per Date Of Service.
0008U – Helicobacter Pylori Detection And Antibiotic Resistance, Dna, 16S And 23S Rrna, Gyra, Pbp1, Rdxa And Rpob, Next Generation Sequencing, Formalin-Fixed Paraffin-Embedded Or Fresh Tissue Or Fecal Sample, Predictive, Reported As Positive Or Negative For Resistance To Clarithromycin, Fluoroquinolones, Metronidazole, Amoxicillin, Tetracycline, And Rifabutin.
0009U – Oncology (Breast Cancer), Erbb2 (Her2) Copy Number By Fish, Tumor Cells From Formalin-Fixed Paraffin-Embedded Tissue Isolated Using Image-Based Dielectrophoresis (Dep) Sorting, Reported As Erbb2 Gene Amplified Or Non-Amplified.
Guidelines from insurances
CPT Code 0007U
Max unit: 1
Minimum age: 18 Years
Maximum age: 120 Years
NDC code required: No
CLIA required: No
Authorization or referral required: No
Allowed in OP and IP settings;
Not allowed in ED or home health settings;
Allowed in CPT and HCPCS TOS
CPT Code 0008U
Max unit: 1
Minimum age: 18
Maximum age: 120
NDC code required: No
CLIA required: No
Authorization or referral required: No
Allowed in OP and IP settings;
Not allowed in ED or home health settings;
Allowed in CPT and HCPCS TOS
CPT Code 0009U
Max unit: 1
Minimum age: 18
Maximum age: 120
NDC code required: No
CLIA required: No
Authorization or referral required: No
Allowed in OP and IP settings;
Not allowed in ED or home health settings;
Medicare billing and coding guidelines
- Medicare Coverage Database: The Centers for Medicare & Medicaid Services (CMS) maintains a database where you can search for specific CPT codes and view the coverage details for different Medicare carriers and contractors. You can access it through the CMS website.
- American Medical Association (AMA): The AMA provides detailed documentation on CPT code usage, guidelines, and modifier usage in their CPT codebook.
- Local Medicare Administrative Contractor (MAC): Each region has its own MAC, which provides specific guidelines and local coverage determinations for Medicare beneficiaries in that area. You can find the appropriate MAC for your region on the CMS website.
- Medicare Part B Bulletins: CMS periodically releases bulletins that contain updates and changes to Medicare coverage policies and guidelines. These bulletins can provide valuable insights into coding and billing practices.
- Professional Medical Organizations: Specialized medical organizations often publish articles, webinars, and guidelines related to specific CPT codes and Medicare coverage.
Common Questions and Answers:
- Q1: Does Medicare cover all medical services and procedures?
- A1: No, Medicare covers a wide range of services, but it doesn’t cover everything. Some services may require co-payments, deductibles, or may not be covered at all.
- Q2: How can I find out if a specific service is covered by Medicare?
- A2: You can check coverage for specific services by visiting the official Medicare website or by contacting Medicare directly. You can also consult with your healthcare provider or the Medicare Advantage plan if you have one.
- Is it possible to enroll in both Medicare Part B and a Medicare Advantage Plan at the same time?
- A3: No, you cannot have both at the same time. If you enroll in a Medicare Advantage Plan, it will replace your Part B coverage.
- Q4: What should I do if my claim gets denied?
- A4: If your claim is denied, review the explanation of benefits (EOB) to understand the reason for the denial. If you believe the denial is incorrect, you can appeal the decision and provide additional documentation to support your case
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- Question 5: Am I able to use any hospital or doctor with Medicare?
- A5: With Original Medicare (Part A and Part B), you can generally use any doctor or hospital that accepts Medicare patients. However, if you have a Medicare Advantage Plan, you may need to use the plan’s network of providers.
