CodeMap® Report 87497
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2018 ICD-10 Diagnosis Code Set Loaded     


10/01/2017 NCD Edits Loaded     


2017-D October DME Fee Schedule     


2017-A PEN Fee Schedule-no changes for rest of 2017     


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2017-D October APC Fee Schedule Updated     


October 2017 ASP Drug Pricing Updated     


Q4 2017 CCI Edits Loaded     


Q4 2017 MUE Edits Loaded     


LCD Database Current Through 10/16/2017     

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87496
Quick jump to procedure code: Printer Friendly Version
87498

87497: Cytomeg dna quant

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


Short Description: Cytomeg dna quant

--

CPT copyright 2016 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
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
2017 Laboratory Fee Schedule: $58.76


2017 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.
Percentage
ICD-10 Code
Description
Related DRG(s)
22.1%
Z94.0
Kidney transplant status
008
698-700
8.5%
Z94.2
Lung transplant status
205-206
5.4%
Z94.4
Liver transplant status
441-443
5.0%
B25.9
Cytomegaloviral disease, unspecified
865-866
974-976
4.2%
T86.10
Unspecified complication of kidney transplant
698-700
3.7%
Z48.22
Encounter for aftercare following kidney transplant
945-946
949-950
2.9%
Z79.899
Other long term (current) drug therapy
949-950
2.9%
Z48.23
Encounter for aftercare following liver transplant
945-946
949-950
2.8%
Z94.1
Heart transplant status
314-316
2.4%
C92.01
Acute myeloblastic leukemia, in remission
820-822
834-836
837-839

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

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.

Column 1 CCI Edits for 87497
Denied Codes (1)
Effective
Modifier
Accepted (2)
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
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
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.



Column 2 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
81287 Mgmt gene methylation anal
01/01/2015 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
81288 Mlh1 gene
01/01/2015 Yes
81290 Mcoln1 gene
01/01/2015 Yes
81291 Mthfr gene
01/01/2015 Yes
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
81327 Sept9 methylation analysis
01/01/2017 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
87483 Cns dna amp probe type 12-25
01/01/2017 No
87495 Cytomeg dna dir probe
04/01/2003 Yes
87496 Cytomeg dna amp probe
04/01/2003 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*
WILLIAM MORICE -ROCHESTER,MN 952
CURTIS HANSON -ROCHESTER,MN 152
JOHN ROBACK -ATLANTA,GA 37
KANDICE MARCHANT -CLEVELAND,OH 35
TERENCE CASEY -BRENTWOOD,TN 35

   87497 Top 5 Ordering Organizations National*
LABORATORY CORPORATION OF AMERICA HOLDINGS-NC 5,662
MAYO CLINIC JACKSONVILLE-FL 3,107
UNIVERSITY OF MIAMI-FL 2,187
LABORATORY CORPORATION OF AMERICA HOLDINGS-NJ 1,652
BIO REFERENCE LABORATORIES, INC-NJ 1,539

*Based on 2015 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 2016: 47,913
Total Services Denied 2016: 5,244 (10.9%)
National Charges Submitted 2016: $ 17,297,056.92
National Charges Allowed 2016: $ 2,185,390.87
National Average (No Modifier) Fee Submitted 2016: $300.47
National Average (No Modifier) Fee Allowed 2016: $ 52.82
National Average (26) Fee Submitted 2016: $ 83.69
National Average (26) Fee Allowed 2016: $ 0.00


Top 5 Performing Specialties 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
46,108 96.2% $370.93 5,009 10.9%
Pathology 1,566 3.3% $ 97.39 116 7.4%
Pediatric medicine 84 0.2% $ 83.57 84 100.0%
Family practice 46 0.1% $303.55 2 4.3%
Hematology/oncology
(eff 5/92)
46 0.1% $140.68 14 30.4%

Top 5 Places of Service 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 45,921 95.8% $370.79 5,002 10.9%
Office 1,852 3.9% $136.53 145 7.8%
Outpatient hospital 92 0.2% $115.97 86 93.5%
Skilled nursing facility 24 0.1% $105.92 2 8.3%
Rural health clinic 10 0.0% $189.00 3 30.0%

Top 5 Modifiers Submitted 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
90 - Reference (Outside) Laboratory 23,433 48.9% $428.08 1,983 8.5%
No Modifier 22,852 47.7% $300.47 2,526 11.1%
59 - Distinct Procedural Service 1,162 2.4% $207.80 414 35.6%
GA - Advanced Beneficiary Notice (ABN) on File 242 0.5% $429.87 180 74.4%
26 - Professional Component 85 0.2% $ 83.69 85 100.0%

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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10/21/2017 03:15:36 54.81.131.189

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