2024 CPT CODE UPDATES
Test# Test Name Old CPT (2023) New CPT (2024)
452 Acetylcholine Receptor Binding Antibody 83519 86041
10006 Acetylcholine Receptor Modulating Antibody 83516 86043
2417 Acetylcholine Receptor Blocking Antibody 86042 83516
8204 Anti-Mullerian Hormone 83520 82166
10260 Myasthenia Gravis Reflexive Panel 83519,83516 86041,86042
10396 Muscle-Specific Kinase (MuSK) Antibody 86255 86366
LIPID PROFILE MEDICAL NECESSITY (FREQUENCY LIMIT OF ONCE PER YEAR)
Please note that Lipid Testing falls under National Coverage Determination 190.23. The following is stated in this determination:
When monitoring long term anti-lipid dietary or pharmacologic therapy and when following patients with borderline high total or LDL cholesterol levels, it may be reasonable to perform the lipid panel annually. A lipid panel at a yearly interval will usually be adequate while measurement of the serum total cholesterol or a measured LDL should suffice for interim visits if the patient does not have hypertriglyceridemia.
Medicare will only cover Lipid testing once per year for monitoring of long-term anti-lipid dietary or pharmacologic therapy and when following patients with borderline high total or LDL cholesterol levels. If you order a Lipid test more frequently than once per year, you must provide a signed ABN and/or clinical notes showing why this testing was medically necessary.
EFFECTIVE IMMEDIATELY-CHANGE TO RESPIRATORY CULTURE TESTING
#2614 Respiratory Culture w/Gram Stain will no longer automatically include a gram stain result for throat sources as it is not indicated for this source. Gram stain testing will only be reported for sinus, bronchial, and other types of respiratory testing.
Test #688 Beta strep screen is the recommended test for a throat source since it checks for the most common cause of pharyngitis that warrants therapy (Group A strep). Beta strep screen also checks for predominant growth of Group C and G strep along with predominant Arcanobacterium haemolyticum.
When respiratory culture #2614 is ordered for a throat source it should be considered an infrequent 'special request' to check for unusual organisms such as yeast, or Neisseria gonorrhoeae. Please indicate what organism the provider is screening for on the requisition so it can be documented on the report.
BILLING / EMR UPDATE MAY BE REQUIRED
Please note that you may need to update your EMR or billing system to ensure accurate coding. The gram stain (CPT 87205) will only be performed and billed when a respiratory source is indicated.
Example 1:
Test #2614 Respiratory Culture w/ Gram Stain is ordered with a source of throat ~ Only a respiratory culture will be performed ~ CPT 87070 billed.
Example 2:
Test #2614 Respiratory Culture w/ Gram Stain is ordered with a source of sinus ~ A respiratory culture and gram stain will be performed ~ CPT 87070, 87205 billed.
If you have any questions regarding this change, please contact Jean Fisher at (402)731-4145 or jfisher@physlab.com.