2021 CPT Code Changes and Updates for Laboratories

UPDATE: The 2% Payment Adjustment (Sequestration) that was extended through March 31, 2021, for Medicare patients as part of the CARES Act has been further extended through December 31, 2021, through a law signed into effect on April 14, 2021.

It’s a new year and the American Medical Association’s (AMA) Current Procedural Terminology (CPT) changes have taken effect. With 329 changes total (overall, fewer than usual), pathology and laboratories are seeing the most changes to their CPT and HCPCS coding structure. This includes the continuing expansion of the Proprietary Laboratory Analyses section of the code set and the addition of codes related to COVID-19 or SARS-CoV-2.

According to the AMA, “The CPT code set continues to see growth in new and novel areas of medicine, with the majority (63%) of new codes involving new technology”. The changes were in effect as of January 1, 2021.

2021 Medicare Physician Fee Schedule

CMS released the 2021 Medicare Physician Fee Schedule outlining payment on all Medicare tests and procedures. One big change which has many concerned is the Finalized Conversion Factor of $31.41 (a $3.68 decrease from 2020). While this recognizes a budget neutrality adjustment required by law to offset the changes meant to benefit primary care providers, it has created serious concern for specialty care providers, including pathology, who will take the financial hit.

While pathology and laboratories receive over 80% of their Medicare revenue from services paid under the clinical Laboratory Fee Schedule (CLFS), the College of American Pathologists anticipate that pathology will see an 8% decrease in reimbursement depending on the physician’s payor and case mix. This decrease is a result of revisions to the relative value units (RVUs) for evaluation and management (E/M) services that have gone through a major overhaul which negatively impacts specialty care and testing services.

Pathology and Laboratory Code Updates

Therapeutic Drug Assays – New Codes for 2021

Tier I Molecular Pathology Procedures – New Codes for 2021

• 81168 CCND1/IGH (t{11;14}) (e.g., mantle cell lymphoma) translocation analysis, major breakpoint, qualitative and quantitative, if performed

• 81191 NTRK1 (neurotrophic receptor tyrosine kinase 1) (e.g., solid tumors) translocation analysis

• 81192 NTRK2 (neurotrophic receptor tyrosine kinase 2) (e.g., solid tumors) translocation analysis

• 81193 NTRK3 (neurotrophic receptor tyrosine kinase 3) (e.g., solid tumors) translocation analysis

• 81194 NTRK (NEUROTROPHIC-TROPOMYOSIN RECEPTOR TYROSINE KINASE 1, 2, and 3) (e.g., solid tumors) translocation analysis

• 81278 IHG@/BCL2 (t(14;18))) (e.g., follicular lymphoma) translocation analysis, major breakpoint region (MBR) and minor cluster region (mcr) breakpoints, qualitative or quantitative

• 81279 JAK2 (Janus kinase 2) (e.g., myeloproliferative disorder) targeted sequence analysis (eg. Exons 12 and 13)

• 81338 MPL (MPL proto-oncogene, thrombopoietin receptor) (eg myeloproliferative disorder) gene analysis; common variants (e.g., W515A, W515K, W515L, W515R)

• 81339 MPL (MPL proto-oncogene, thrombopoietin receptor) (eg myeloproliferative disorder) gene analysis; sequence analysis, exon 10

• 81347 SF3B1 (splicing factor [3b] subunit B1) (eg. Myelodysplastic syndrome/acute myeloid leukemia) gene analysis, common variants (e.g., A672T, E622D, L833F, R625C, R625L)

• 81348 SRSF2 (serine and arginine-rich splicing factor 2) (e.g., myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variants (e.g., P95H, P95L)

• 81351 TP53 (tumor protein 53) (e.g., Li-Fraumeni syndrome) gene analysis; full gene sequence

• 81352 TP53 (tumor protein 53) (e.g., Li-Fraumeni syndrome) gene analysis; targeted sequence analysis (e.g., 4 oncology)

• 81353 TP53 (tumor protein 53) (e.g., Li-Fraumeni syndrome) gene analysis; unknown familial variant

• 81357 U2AF1 (U2 small nuclear RNA auxiliary factor 1) (e.g., myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variants (e.g., S34F, S34Y, Q157R, Q157P)

• 81360 ZRSR2 (zinc finger CCCH-type, RNA binding motif and serine/arginine-rich 2) (e.g., myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variant(s) (e.g., E65fs, E12fs, R448fs)

• 81419 Epilepsy genomic sequence analysis panel, must include analyses for ALDH7A1, CACNA1A, CHKL5, CHD2, GABRG2, KCNQ2, MECP2, PCDH19, POLG, PRRT2, SCN1A, SCN1B, SCN2A, SCN8A, SLC2A1, SLC9A6, STXBP1, SYNGAP1, TCF4, TPP1, TSC1, TSC2, and ZEB2

• 81513 Infectious disease, bacterial vaginosis, quantitative real-time amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species, utilizing vaginal-fluid specimens, algorithm reported as a positive or negative result for bacterial vaginosis

• 81514 Infectious disease, bacterial vaginosis and vaginitis, quantitative real-time amplification of DNA markers for Gardnerella vaginalis, Atopobium vaginae, Megasphaera type 1, Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), and Lactobacilus species (L. crispatus and L. jensenii), utilizing vaginal-fluid specimens, algorithm reported as a positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and/or Candida species (C. albicans, C tropicalis, C. parapsilosis, C dubliniensis), Candida glabrata, Candida krusei, when reported

• 81529 Oncology (cutaneous melanoma), mRNA, gene expression profiling by real-time RT-PCR of 31 genes (28 content and 3 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk, including likelihood of sentinel lymph node metastasis

• 81546 Oncology (thyroid), mRNA, gene expression analysis of 10,196 genes, utilizing fine needle aspirate, algorithm reported as categorical result (e.g., benign or suspicious)

• 81554 Pulmonary disease (idiopathic pulmonary fibrosis [IPF]) mRNA, gene expression analysis of 190 genes, utilizing transbronchial biopsies, diagnostic algorithm, reported as categorical result (e.g., positive or negative for high probability of usual interstitial pneumonia [UIP])

Revised Code for 2021

• 80415 Chorionic gonadotropin stimulation panel; estradiol response this panel must include the following, Estradiol, total (82670 x 2 or 3 pooled blood samples)

Tier II Molecular Pathology Procedures

Revised Codes for 2021 – Please see CPT Code Set for Specific Long Descriptions

• 81401 Molecular pathology procedure, Level 2

• 81402 Molecular pathology procedure, Level 3

• 81403 Molecular pathology procedure, Level 4

• 81404 Molecular pathology procedure, Level 5

• 81405 Molecular pathology procedure, Level 6

These codes have extensive long descriptions, but removing a tumor protein is the issue.

Multianalyte Assays with Algorithmic Analyses

Deleted Code for 2021

• 81545 Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (e.g., benign or suspicious)

Chemistry

New Codes for 2021

• 82077 Alcohol (ethanol); any specimen except urine and breath immunoassay (e.g., IA, EIA, ELISA, RIA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)

• 82681 Estradiol; free, direct measurement (e.g., equilibrium dialysis)

Revised Codes for 2021

• 82075 Alcohol (ethanol); breath

• 82670 Estradiol; total

Proprietary Laboratory Analyses

New Codes for 2021

• 0068U Candida species panel (C. albicans, C. glabrata, C. parapsilosis, C. kruseii, C. tropicalis, and C. auris), amplified probe technique with qualitative report of the presence or absence of each species

• 0139U Neurology (autism spectrum disorder [ASD]), quantitative measurements of 6 central carbon metabolites (i.e., αketoglutarate, alanine, lactate, phenylalanine, pyruvate, and succinate), LCMS/MS, plasma, algorithmic analysis with result reported as negative or positive (with metabolic subtypes of ASD)

• 0140U Infectious disease (fungi), fungal pathogen identification, DNA (15 fungal targets), blood culture, amplified probe technique, each target reported as detected or not detected

• 0141U Infectious disease (bacteria and fungi), gram-positive organism identification and drug resistance element detection, DNA (20 gram-positive bacterial targets, 4 resistance genes, 1 pan gram negative bacterial target,1 pan Candida target), blood culture, amplified probe technique, each target reported as detected or not detected

• 0142U Infectious disease (bacteria and fungi), gram-negative bacterial identification and drug resistance element detection, DNA (21 gram-negative bacterial targets, 6 resistance genes, 1 pan gram positive bacterial target, 1 pan Candida target), amplified probe technique, each target reported as detected or not detected

• 0143U Drug assay, definitive, 120 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service (For additional PLA code with identical clinical descriptor, see 0150U See Appendix O to determine appropriate code assignment)

• 0144U Drug assay, definitive, 160 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service

• 0145U Drug assay, definitive, 65 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service

• 0146U Drug assay, definitive, 80 or more drugs or metabolites, urine, by quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service

• 0147U Drug assay, definitive, 85 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service

• 0148U Drug assay, definitive, 100 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service

• 0149U Drug assay, definitive, 60 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service

• 0150U Drug assay, definitive, 120 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service (For additional PLA code with identical clinical descriptor, see 0143U See Appendix O to determine appropriate code assignment)

• 0151U Infectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 33 targets, real-time semi-quantitative PCR, bronchoalveolar lavage, sputum, or endotracheal aspirate, detection of 33 organismal and antibiotic resistance genes with limited semi-quantitative results

• 0152U Infectious disease (bacteria, fungi, parasites, and DNA viruses), DNA, PCR and next generation sequencing, plasma, detection of >1,000 potential microbial organisms for significant positive pathogens

• 0153U Oncology (breast), mRNA, gene expression profiling by next-generation sequencing of 101 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a triple negative breast cancer clinical subtype(s) with information on immune cell involvement

• 0156U Copy number (e.g., intellectual disability, dysmorphology), sequence analysis

• 0163U Oncology (colorectal) screening, biochemical enzyme-linked immunosorbent assay (ELISA) of 3 plasma or serum proteins (teratocarcinoma derived growth factor-1 [TDGF-1, Cripto1], carcinoembryonic antigen [CEA], extracellular matrix protein [ECM]), with demographic data (age, gender, CRC screening compliance) using a proprietary algorithm and reported as likelihood of CRC or advanced adenomas

• 0164U Gastroenterology (irritable bowel syndrome [IBS]), immunoassay for antiCdtB and anti-vinculin antibodies, utilizing plasma, algorithm for elevated or not elevated qualitative results

• 0166U Liver disease, 10 biochemical assays (α2- macroglobulin, haptoglobin, apolipoprotein A1, bilirubin, GGT, ALT, AST, triglycerides, cholesterol, fasting glucose) and biometric and demographic data, utilizing serum, algorithm reported as scores for fibrosis, necro inflammatory activity, and steatosis with a summary interpretation

• 0167U Gonadotropin, chorionic (hCG), immunoassay with direct optical observation

• 0168U Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence analysis of selected regions using maternal plasma without fetal fraction cutoff, algorithm reported as a risk score for each trisomy

• 0169U NUDT15 (nudix hydrolase 15) and TPMT (thiopurine S-methyltransferase) (e.g., drug metabolism) gene analysis, common variants

• 0170U Neurology (autism spectrum disorder [ASD]), RNA, next-generation sequencing, saliva, algorithmic analysis, and results reported as predictive probability of ASD diagnosis

• 0171U Targeted genomic sequence analysis panel, acute myeloid leukemia, myelodysplastic syndrome, and myeloproliferative neoplasms, DNA analysis, 23 genes, interrogation for sequence variants, rearrangements and minimal residual disease, reported as presence/absence

• 0172U Oncology (solid tumor as indicated by the label), somatic mutation analysis of BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) and analysis of homologous recombination deficiency pathways, DNA, formalin-fixed paraffin-embedded tissue, algorithm quantifying tumor genomic instability score

• 0173U Psychiatry (i.e., depression, anxiety), genomic analysis panel, includes variant analysis of 14 genes

• 0174U Oncology (solid tumor), mass spectrometric 30 protein targets, formalin-fixed paraffin embedded tissue, prognostic and predictive algorithm reported as likely, unlikely, or uncertain benefit of 39 chemotherapy and targeted therapeutic oncology agents

• 0175U Psychiatry (e.g., depression, anxiety), genomic analysis panel, variant analysis of 15 genes

• 0176U Cytolethal distending toxin B (CdtB) and vinculin IgG antibodies by immunoassay (i.e., ELISA)

• 0177U Oncology (breast cancer), DNA, PIK3CA (phosphatidylinositol-4, 5-bisphosphate 3- kinase catalytic subunit alpha) gene analysis of 11 gene variants utilizing plasma, reported as PIK3CA gene mutation status

• 0178U Peanut allergen-specific quantitative assessment of multiple epitopes using enzyme-linked immunosorbent assay (ELISA), blood, report of minimum eliciting exposure for a clinical reaction

• 0179U Oncology (non-small cell lung cancer), cell-free DNA, targeted sequence analysis of 23 genes (single nucleotide variations, insertions and deletions, fusions without prior knowledge of partner/breakpoint, copy number variations), with report of significant mutation(s)

• 0180U Red cell antigen (ABO blood group) genotyping (ABO), gene analysis Sanger/chain termination/conventional sequencing, ABO (ABO, alpha 1-3-Nacetylgalactosaminyltransferase and alpha 1-3-galactosyltransferase) gene, including subtyping, 7 exons

• 0181U Red cell antigen (Colton blood group) genotyping (CO), gene analysis, AQP1 (aquaporin 1 [Colton blood group]) exon 1

• 0182U Red cell antigen (Cromer blood group) genotyping (CROM), gene analysis, CD55 (CD55 molecule [Cromer blood group]) exons 1-10

• 0183U Red cell antigen (Diego blood group) genotyping (DI), gene analysis, SLC4A1 (solute carrier family 4 member 1 [Diego blood group]) exon 19

• 0184U Red cell antigen (Dombrock blood group) genotyping (DO), gene analysis, ART4 (ADPribosyltransferase 4 [Dombrock blood group]) exon 2

• 0185U Red cell antigen (H blood group) genotyping (FUT1), gene analysis, FUT1 (fucosyltransferase 1 [H blood group]) exon 4

• 0186U Red cell antigen (H blood group) genotyping (FUT2), gene analysis, FUT2 (fucosyltransferase 2) exon 2

• 0187U Red cell antigen (Duffy blood group) genotyping (FY), gene analysis, ACKR1 (atypical chemokine receptor 1 [Duffy blood group]) exons 1-2

• 0188U Red cell antigen (Gerbich blood group) genotyping (GE), gene analysis, GYPC (glycophorin C [Gerbich blood group]) exons 1-4

• 0189U Red cell antigen (MNS blood group) genotyping (GYPA), gene analysis, GYPA (glycophorin A [MNS blood group]) introns 1, 5, exon 2

• 0190U Red cell antigen (MNS blood group) genotyping (GYPB), gene analysis, GYPB (glycophorin B [MNS blood group]) introns 1, 5, pseudoexon 3

• 0191U Red cell antigen (Indian blood group) genotyping (IN), gene analysis, CD44 (CD44 molecule [Indian blood group]) exons 2, 3, 6

• 0192U Red cell antigen (Kidd blood group) genotyping (JK), gene analysis, SLC14A1 (solute carrier family 14 member 1 [Kidd blood group]) gene promoter, exon 9

• 0193U Red cell antigen (JR blood group) genotyping (JR), gene analysis, ABCG2 (ATP binding cassette subfamily G member 2 [Junior blood group]) exons 2- 26

• 0194U Red cell antigen (Kell blood group) genotyping (KEL), gene analysis, KEL (Kell metalloendopeptidase [Kell blood group]) exon 8

• 0195U KLF1 (Kruppel-like factor 1), targeted sequencing (i.e., exon 13)

• 0196U Red cell antigen (Lutheran blood group) genotyping (LU), gene analysis, BCAM (basal cell adhesion molecule [Lutheran blood group]) exon 3

• 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

• 0200U Red cell antigen (Kx blood group) genotyping (XK), gene analysis, XK (X-linked Kx blood group) exons 1-3

• 0201U Red cell antigen (Yt blood group) genotyping (YT), gene analysis, ACHE (acetylcholinesterase [Cartwright blood group]) exon 2

• 0202U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected

• 0203U Autoimmune (inflammatory bowel disease), mRNA, gene expression profiling by quantitative RT-PCR, 17 genes (15 target and 2 reference genes), whole blood, reported as a continuous risk score and classification of inflammatory bowel disease aggressiveness

• 0204U Oncology (thyroid), mRNA, gene expression analysis of 593 genes (including BRAF, RAS, RET, PAX8, and NTRK) for sequence variants and rearrangements, utilizing fine needle aspirate, reported as detected or not detected

• 0205U Ophthalmology (age-related macular degeneration), analysis of 3 gene variants (2 CFH gene, 1 ARMS2 gene), using PCR and MALDI-TOF, buccal swab, reported as positive or negative for neovascular age-related macular-degeneration risk associated with zinc supplements

• 0206U Neurology (Alzheimer disease); cell aggregation using morphometric imaging and protein kinase C-epsilon (PKCe) concentration in response to amylospheroid treatment by ELISA, cultured skin fibroblasts, each reported as positive or negative for Alzheimer disease

• 0208U Oncology (medullary thyroid carcinoma), mRNA, gene expression analysis of 108 genes, utilizing fine needle aspirate, algorithm reported as positive or negative for medullary thyroid carcinoma

• 0209U Cytogenomic constitutional (genome-wide) analysis, interrogation of genomic regions for copy number, structural changes and areas of homozygosity for chromosomal abnormalities

• 0210U Syphilis test, non-treponemal antibody, immunoassay, quantitative (RPR)

• 0211U Oncology (pan-tumor), DNA and RNA by next-generation sequencing, utilizing formalin-fixed paraffin-embedded tissue, interpretative report for single nucleotide variants, copy number alterations, tumor mutational burden, and microsatellite instability, with therapy association

• 0212U Rare diseases (constitutional/heritable disorders), whole genome and mitochondrial DNA sequence analysis, including small sequence changes, deletions, duplications, short tandem repeat gene expansions, and variants in non-uniquely mappable regions, blood or saliva, identification and categorization of genetic variants, proband (Do not report 0212U in conjunction with 81425)

• 0213U Rare diseases (constitutional/heritable disorders), whole genome and mitochondrial DNA sequence analysis, including small sequence changes, deletions, duplications, short tandem repeat gene expansions, and variants in non-uniquely mappable regions, blood or saliva, identification and categorization of genetic variants, each comparator genome (e.g., parent, sibling) (Do not report 0213U in conjunction with 81426)

• 0214U Rare diseases (constitutional/heritable disorders), whole exome and mitochondrial DNA sequence analysis, including small sequence changes, deletions, duplications, short tandem repeat gene expansions, and variants in non-uniquely mappable regions, blood or saliva, identification and categorization of genetic variants, proband (Do not report 0214U in conjunction with 81415)

• 0215U Rare diseases (constitutional/heritable disorders), whole exome and mitochondrial DNA sequence analysis, including small sequence changes, deletions, duplications, short tandem repeat gene expansions, and variants in non-uniquely mappable regions, blood or saliva, identification and categorization of genetic variants, each comparator exome (e.g., parent, sibling) (Do not report 0215U in conjunction with 81416)

• 0216U Neurology (inherited ataxias), genomic DNA sequence analysis of 12 common genes including small sequence changes, deletions, duplications, short tandem repeat gene expansions, and variants in non-uniquely mappable regions, blood or saliva, identification and categorization of genetic variants

• 0217U Neurology (inherited ataxias), genomic DNA sequence analysis of 51 genes including small sequence changes, deletions, duplications, short tandem repeat gene expansions, and variants in non-uniquely mappable regions, blood or saliva, identification and categorization of genetic variants

• 0218U Neurology (muscular dystrophy), DMD gene sequence analysis, including small sequence changes, deletions, duplications, and variants in non-uniquely mappable regions, blood or saliva, identification and characterization of genetic variants

• 0219U Infectious agent (human immunodeficiency virus), targeted viral next-generation sequence analysis (i.e., protease [PR], reverse transcriptase [RT], integrase [INT]), algorithm reported as prediction of antiviral drug susceptibility

• 0220U Oncology (breast cancer), image analysis with artificial intelligence assessment of 12 histologic and immunohistochemical features, reported as a recurrence score

• 0221U Red cell antigen (ABO blood group) genotyping (ABO), gene analysis, next-generation sequencing, ABO (ABO, alpha 1-3-N-acetylgalactosaminyltransferase and alpha 1-3- galactosyltransferase) gene

• 0222U Red cell antigen (RH blood group) genotyping (RHD and RHCE), gene analysis, next-generation sequencing, RH proximal promoter, exons 1-10, portions of introns 2-3

Add-On Codes for 2021

• +0157U APC (APC regulator of WNT signaling pathway) (e.g., familial adenomatosis polyposis[FAP]) mRNA sequence analysis (List separately in addition to code for primary procedure) (Use 0157U in conjunction with 81201)

• +0158U MLH1 (mutL homolog 1) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) (Use 0158U in conjunction with 81292)

• +0159U MSH2 (mutS homolog 2) (e.g., hereditary colon cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) (Use 0159U in conjunction with 81295)

• +0160U MSH6 (mutS homolog 6) (e.g., hereditary colon cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) (Use 0160U in conjunction with 81298)

• +0161U PMS2 (PMS1 homolog 2, mismatch repair system component) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) (Use 0161U in conjunction with 81317)

• +0162U Hereditary colon cancer (Lynch syndrome), targeted mRNA sequence analysis panel (MLH1, MSH2, MSH6, PMS2) (List separately in addition to code for primary procedure) (Use 0162U in conjunction with 81292, 81295, 81298, 81317, 81435)

• +0207U Quantitative imaging of phosphorylated ERK1 and ERK2 in response to bradykinin treatment by in situ immunofluorescence, using cultured skin fibroblasts, reported as a probability index for Alzheimer disease (List separately in addition to code for primary procedure) (Use 0207U in conjunction with 0206U)

Deleted Codes for 2021

• 0081U Oncology (uveal melanoma) mRNA, gene-expression profiling by real-time RT-PCR of 15 genes (12, content and 3 housekeeping genes), utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue, algorithm reported as a risk of metastasis Deleted crosswalk CPT 81552

• 0104U Hereditary pan cancer (e.g., hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer, genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA and array CGH, with mRNA analytics to resolve variants of unknown significance when indicated (32 genes [sequencing and deletion/duplication] EPCAM and GREM1 [deletion/duplication only])

Source: AMA’s Current Procedural Terminology (CPT) 2021

For additional codes pertaining to Laboratory testing and procedures related to COVID-19, please refer to the Infinx COVID-19 Resource Center here.

A Final Thought

With pathology and laboratory reimbursement facing added strain, there has never been a better time to consider a third-party partnership for your coding and billing process. With a third-party partner coding team, you can rest assured that changes have been thoroughly researched and reviewed and any possible modifications or adaptations are implemented immediately.

Contact us to learn more about the 2021 proposed laboratory changes or to discuss the benefits of a third-party coding and billing relationship.