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87496
Quick jump to procedure code: Printer Friendly Version
87498

CPT® 87497: INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS, QUANTIFICATION

Short Description: Cytomeg dna quant

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State
2016 Laboratory Fee Schedule: $58.35

Revenue Code(s):
306-Laboratory-bacteriology & microbiology



2016 OPPS Status Indicator: Q4

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
16.8% V58.69    Long-term (current) use of other medications Z79.891   Long term (current) use of opiate analgesic
OR:
Z79.899   Other long term (current) drug therapy
14.3% V42.0    Organ or tissue replaced by transplant, kidney Z94.0   Kidney transplant status
6.5% V42.7    Organ or tissue replaced by transplant, liver Z94.4   Liver transplant status
4.6% 078.5    Cytomegaloviral disease B25.9   Cytomegaloviral disease, unspecified
4.5% V42.6    Organ or tissue replaced by transplant, lung Z94.2   Lung transplant status
4.1% 204.10    Chronic lymphoid leukemia, without mention of having achieved remission C91.10   Chronic lymphocytic leukemia of B-cell type not having achieved remission
2.2% 790.8    Viremia, unspecified B34.9   Viral infection, unspecified
2.1% V67.51    Follow-up examination following completed treatment with high-risk medication, not elsewhere classified Z09   Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
1.5% V58.83    Encounter for therapeutic drug monitoring Z51.81   Encounter for therapeutic drug level monitoring
1.4% 070.54    Chronic hepatitis C without hepatic coma B18.2   Chronic viral hepatitis C

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

87497 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 87497

CCI and MUE Edits*         Hide this section.

CCI Edits for 87497
Denied Codes (1)
Effective
Modifier
Accepted (2)
81161 Dmd dup/delet analysis
01/01/2015 Yes
81162 Brca1&2 seq & full dup/del
01/01/2016 Yes
81170 Abl1 gene
01/01/2016 Yes
81200 Aspa gene
01/01/2015 Yes
81201 Apc gene full sequence
01/01/2015 Yes
81202 Apc gene known fam variants
01/01/2015 Yes
81203 Apc gene dup/delet variants
01/01/2015 Yes
81205 Bckdhb gene
01/01/2015 Yes
81206 Bcr/abl1 gene major bp
01/01/2015 Yes
81207 Bcr/abl1 gene minor bp
01/01/2015 Yes
81208 Bcr/abl1 gene other bp
01/01/2015 Yes
81209 Blm gene
01/01/2015 Yes
81210 Braf gene
01/01/2015 Yes
81211 Brca1&2 seq & com dup/del
01/01/2015 Yes
81212 Brca1&2 185&5385&6174 var
01/01/2015 Yes
81213 Brca1&2 uncom dup/del var
01/01/2015 Yes
81214 Brca1 full seq & com dup/del
01/01/2015 Yes
81215 Brca1 gene known fam variant
01/01/2015 Yes
81216 Brca2 gene full sequence
01/01/2015 Yes
81217 Brca2 gene known fam variant
01/01/2015 Yes
81218 Cebpa gene full sequence
01/01/2016 Yes
81219 Calr gene com variants
01/01/2016 Yes
81220 Cftr gene com variants
01/01/2015 Yes
81221 Cftr gene known fam variants
01/01/2015 Yes
81222 Cftr gene dup/delet variants
01/01/2015 Yes
81223 Cftr gene full sequence
01/01/2015 Yes
81224 Cftr gene intron poly t
01/01/2015 Yes
81225 Cyp2c19 gene com variants
01/01/2015 Yes
81226 Cyp2d6 gene com variants
01/01/2015 Yes
81227 Cyp2c9 gene com variants
01/01/2015 Yes
81228 Cytogen micrarray copy nmbr
01/01/2015 Yes
81229 Cytogen m array copy no&snp
01/01/2015 Yes
81235 Egfr gene com variants
01/01/2015 Yes
81240 F2 gene
01/01/2015 Yes
81241 F5 gene
01/01/2015 Yes
81242 Fancc gene
01/01/2015 Yes
81243 Fmr1 gene detection
01/01/2015 Yes
81244 Fmr1 gene characterization
01/01/2015 Yes
81245 Flt3 gene
01/01/2015 Yes
81246 Flt3 gene analysis
01/01/2015 Yes
81250 G6pc gene
01/01/2015 Yes
81251 Gba gene
01/01/2015 Yes
81252 Gjb2 gene full sequence
01/01/2015 Yes
81253 Gjb2 gene known fam variants
01/01/2015 Yes
81254 Gjb6 gene com variants
01/01/2015 Yes
81255 Hexa gene
01/01/2015 Yes
81256 Hfe gene
01/01/2015 Yes
81257 Hba1/hba2 gene
01/01/2015 Yes
81260 Ikbkap gene
01/01/2015 Yes
81261 Igh gene rearrange amp meth
01/01/2015 Yes
81262 Igh gene rearrang dir probe
01/01/2015 Yes
81263 Igh vari regional mutation
01/01/2015 Yes
81264 Igk rearrangeabn clonal pop
01/01/2015 Yes
81265 Str markers specimen anal
01/01/2015 Yes
81266 Str markers spec anal addl
01/01/2015 Yes
81267 Chimerism anal no cell selec
01/01/2015 Yes
81268 Chimerism anal w/cell select
01/01/2015 Yes
81270 Jak2 gene
01/01/2015 Yes
81272 Kit gene targeted seq analys
01/01/2016 Yes
81273 Kit gene analys d816 variant
01/01/2016 Yes
81275 Kras gene variants exon 2
01/01/2015 Yes
81276 Kras gene addl variants
01/01/2016 Yes
81280 Long qt synd gene full seq
01/01/2015 Yes
81281 Long qt synd known fam var
01/01/2015 Yes
81282 Long qt syn gene dup/dlt var
01/01/2015 Yes
81287 Mgmt gene methylation anal
01/01/2015 Yes
81288 Mlh1 gene
01/01/2015 Yes
81290 Mcoln1 gene
01/01/2015 Yes
81291 Mthfr gene
01/01/2015 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
81292 Mlh1 gene full seq
01/01/2015 Yes
81293 Mlh1 gene known variants
01/01/2015 Yes
81294 Mlh1 gene dup/delete variant
01/01/2015 Yes
81295 Msh2 gene full seq
01/01/2015 Yes
81296 Msh2 gene known variants
01/01/2015 Yes
81297 Msh2 gene dup/delete variant
01/01/2015 Yes
81298 Msh6 gene full seq
01/01/2015 Yes
81299 Msh6 gene known variants
01/01/2015 Yes
81300 Msh6 gene dup/delete variant
01/01/2015 Yes
81301 Microsatellite instability
01/01/2015 Yes
81302 Mecp2 gene full seq
01/01/2015 Yes
81303 Mecp2 gene known variant
01/01/2015 Yes
81304 Mecp2 gene dup/delet variant
01/01/2015 Yes
81310 Npm1 gene
01/01/2015 Yes
81311 Nras gene variants exon 2&3
01/01/2016 Yes
81313 Pca3/klk3 antigen
01/01/2015 Yes
81314 Pdgfra gene
01/01/2016 Yes
81315 Pml/raralpha com breakpoints
01/01/2015 Yes
81316 Pml/raralpha 1 breakpoint
01/01/2015 Yes
81317 Pms2 gene full seq analysis
01/01/2015 Yes
81318 Pms2 known familial variants
01/01/2015 Yes
81319 Pms2 gene dup/delet variants
01/01/2015 Yes
81321 Pten gene full sequence
01/01/2015 Yes
81322 Pten gene known fam variant
01/01/2015 Yes
81323 Pten gene dup/delet variant
01/01/2015 Yes
81324 Pmp22 gene dup/delet
01/01/2015 Yes
81325 Pmp22 gene full sequence
01/01/2015 Yes
81326 Pmp22 gene known fam variant
01/01/2015 Yes
81330 Smpd1 gene common variants
01/01/2015 Yes
81331 Snrpn/ube3a gene
01/01/2015 Yes
81332 Serpina1 gene
01/01/2015 Yes
81340 Trb@ gene rearrange amplify
01/01/2015 Yes
81341 Trb@ gene rearrange dirprobe
01/01/2015 Yes
81342 Trg gene rearrangement anal
01/01/2015 Yes
81350 Ugt1a1 gene
01/01/2015 Yes
81355 Vkorc1 gene
01/01/2015 Yes
81370 Hla i & ii typing lr
01/01/2015 Yes
81371 Hla i & ii type verify lr
01/01/2015 Yes
81372 Hla i typing complete lr
01/01/2015 Yes
81373 Hla i typing 1 locus lr
01/01/2015 Yes
81374 Hla i typing 1 antigen lr
01/01/2015 Yes
81375 Hla ii typing ag equiv lr
01/01/2015 Yes
81376 Hla ii typing 1 locus lr
01/01/2015 Yes
81377 Hla ii type 1 ag equiv lr
01/01/2015 Yes
81378 Hla i & ii typing hr
01/01/2015 Yes
81379 Hla i typing complete hr
01/01/2015 Yes
81380 Hla i typing 1 locus hr
01/01/2015 Yes
81381 Hla i typing 1 allele hr
01/01/2015 Yes
81382 Hla ii typing 1 loc hr
01/01/2015 Yes
81383 Hla ii typing 1 allele hr
01/01/2015 Yes
87149 Dna/rna direct probe
04/01/2002 Yes
87150 Dna/rna amplified probe
01/01/2010 Yes
87153 Dna/rna sequencing
01/01/2010 Yes
87253 Virus inoculate tissue addl
04/01/2002 Yes
87332 Cytomegalovirus ag ia
01/01/2003 Yes
87495 Cytomeg dna dir probe
04/01/2003 Yes
87496 Cytomeg dna amp probe
04/01/2003 Yes
80500 Lab pathology consultation
10/30/2000 Yes
80502 Lab pathology consultation
10/30/2000 Yes
81400 Mopath procedure level 1
01/01/2013 Yes
81401 Mopath procedure level 2
01/01/2013 Yes
81402 Mopath procedure level 3
01/01/2013 Yes
81403 Mopath procedure level 4
01/01/2013 Yes
81404 Mopath procedure level 5
01/01/2013 Yes
81405 Mopath procedure level 6
01/01/2013 Yes
81406 Mopath procedure level 7
01/01/2013 Yes
81407 Mopath procedure level 8
01/01/2013 Yes
81408 Mopath procedure level 9
01/01/2013 Yes
87271 Cytomegalovirus dfa
07/01/2004 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 87497.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 87497


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 2 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   87497 Top 5 Ordering Providers National*
FRANKLIN COCKERILL -ROCHESTER,MN 838
CURTIS HANSON -ROCHESTER,MN 314
TERENCE CASEY -BRENTWOOD,TN 22

   87497 Top 5 Ordering Organizations National*
LABORATORY CORPORATION OF AMERICA HOLDINGS-NC 5,673
MAYO CLINIC JACKSONVILLE-FL 2,819
UNIVERSITY OF MIAMI-FL 1,587
LABORATORY CORPORATION OF AMERICA HOLDINGS-NJ 1,387
QUEST DIAGNOSTICS CLINICAL LABORATORIES INC-FL 1,244

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 87497*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 43,537
Total Services Denied 2015: 5,239 (12.0%)
National Charges Submitted 2015: $ 15,585,023.00
National Charges Allowed 2015: $ 1,972,112.00
National Average (No Modifier) Fee Submitted 2015: $302.12
National Average (No Modifier) Fee Allowed 2015: $ 52.91
National Average (26) Fee Submitted 2015: $164.39
National Average (26) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
41,964 96.4% $366.97 4,980 11.9%
Pathology 1,369 3.1% $105.01 124 9.1%
Pediatric medicine 96 0.2% $182.53 96 100.0%
Hematology/oncology
(eff 5/92)
43 0.1% $182.58 10 23.3%
Hematology
(eff 5/92)
16 0.0% $307.00 2 12.5%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 41,788 96.0% $367.24 4,948 11.8%
Office 1,601 3.7% $135.17 150 9.4%
Outpatient hospital 108 0.2% $170.75 108 100.0%
Inpatient hospital 19 0.0% $148.08 17 89.5%
Nursing facility 16 0.0% $ 54.05 14 87.5%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 21,610 49.6% $302.12 2,460 11.4%
90 - Reference (Outside) Laboratory 20,653 47.4% $424.05 2,175 10.5%
59 - Distinct Procedural Service 901 2.1% $202.84 326 36.2%
GA - Advanced Beneficiary Notice (ABN) on File 154 0.4% $424.54 111 72.1%
26 - Professional Component 109 0.3% $164.40 109 100.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


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08/31/2016 02:50:15 54.224.128.150

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