HMSA requires additional information to determine the appropriate application of plan benefits for the following services. When submitting claims for the services listed below, please include the requested documentation.
| CPT Code | Description | Documentation Required |
|---|---|---|
| 0009M | Fetal aneuploidy (trisomy 21 and 18) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy | Clinical notes |
| 0087T (Category III code) | Sperm evaluation, Hyaluron sperm binding test | Clinical notes |
| 0501T | Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; data preparation and transmission, analysis of fluid dynamics and simulated maximal coronary hyperemia, generation of estimated FFR model, with anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report | Clinical notes |
| 0502T | Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; data preparation and transmission | Clinical notes |
| 0503T | Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; analysis of fluid dynamics and simulated maximal coronary hyperemia, and generation of estimated FFR model | Clinical notes |
| 0504T | Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report | Clinical notes |
| 0623T | Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; data preparation and transmission, computerized analysis of data, with review of computerized analysis output to reconcile discordant data, interpretation and report | Clinical notes |
| 0624T | Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; data preparation and transmission | Clinical notes |
| 0625T | Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; computerized analysis of data from coronary computed tomographic angiography | Clinical notes |
| 0626T | Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; review of computerized analysis output to reconcile discordant data, interpretation and report | Clinical notes |
| 0631T | Transcutaneous visible light hyperspectral imaging measurement of oxyhemoglobin, deoxyhemoglobin, and tissue oxygenation, with interpretation and report, per extremity | Clinical notes |
| 0686T | Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance | Clinical notes |
| 0877T | Augmentative analysis of chest computed tomography (ct) imaging data to provide categorical diagnostic subtype classification of interstitial lung disease; obtained without concurrent ct examination of any structure contained in previously acquired diagnostic imaging | Clinical notes |
| 0878T | Augmentative analysis of chest computed tomography (ct) imaging data to provide categorical diagnostic subtype classification of interstitial lung disease; obtained with concurrent ct examination of the same structure | Clinical notes |
| 0879T | Augmentative analysis of chest computed tomography (ct) imaging data to provide categorical diagnostic subtype classification of interstitial lung disease; radiological data preparation and transmission | Clinical notes |
| 0880T | Augmentative analysis of chest computed tomography (ct) imaging data to provide categorical diagnostic subtype classification of interstitial lung disease; physician or other qualified health care professional interpretation and report | Clinical notes |
| 0898T | Noninvasive prostate cancer estimation map, derived from augmentative analysis of image-guided fusion biopsy and pathology, including visualization of margin volume and location, with margin determination and physician interpretation and report | Clinical notes |
| 0899T | Noninvasive determination of absolute quantitation of myocardial blood flow (aqmbf), derived from augmentative algorithmic analysis of the dataset acquired via contrast cardiac magnetic resonance (cmr), pharmacologic stress, with interpretation and report by a physician or other qualified health care professional (list separately in addition to code for primary procedure) | Clinical notes |
| 0900T | Noninvasive estimate of absolute quantitation of myocardial blood flow (aqmbf), derived from assistive algorithmic analysis of the dataset acquired via contrast cardiac magnetic resonance (cmr), pharmacologic stress, with interpretation and report by a physician or other qualified health care professional (list separately in addition to code for primary procedure) | Clinical notes |
| 0028U | Cyp2d6 (cytochrome p450, family 2, subfamily d, polypeptide 6) (eg, drug metabolism) gene analysis, copy number variants, common variants with reflex to targeted sequence analysis | Clinical notes |
| 0039U | Deoxyribonucleic acid (dna) antibody, double stranded, high avidity | Clinical notes (Only for MCR) |
| 0042U | BORRELIA BURGDORFERI, ANTIBODY DETECTION OF 12 RECOMBINANT PROTEIN GROUPS, BY IMMUNOBLOT, IGG | Clinical notes |
| 0064U | ANTIBODY, TREPONEMA PALLIDUM, TOTAL AND RAPID PLASMA REAGIN (RPR), IMMUNOASSAY, QUALITATIVE | Clinical notes |
| 0065U | SYPHILIS TEST, NON-TREPONEMAL ANTIBODY, IMMUNOASSAY, QUALITATIVE (RPR) | |
| 0131U | Hereditary breast cancer–related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), targeted MMA sequence analysis panel (13 genes) (list separately in addition to code for primary procedure)(use 0131U in conjunction with 81162, 81432, 0102U) | Clinical Notes |
| 0132U | Hereditary ovarian cancer–related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), targeted MMA sequence analysis panel (17 genes) (list separately in addition to code for primary procedure)(use 0132U in conjunction with 81162, 81432, 0103U) | Clinical Notes |
| 0134U | Hereditary pan cancer (eg, hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer), targeted MMA sequence analysis panel (18 genes) (list separately in addition to code for primary procedure)(use 0134U in conjunction with 81162, 81432, 81435) | Clinical Notes |
| 0138U | BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) MMA sequence analysis (list separately in addition to code for primary procedure) (use 0138U in conjunction with 81162) | Clinical Notes |
| 0334U | Oncology (solid organ), targeted genomic sequence analysis, formalin-fixed paraffin- embedded (FFPE) tumor tissue, DNA analysis, 84 or more genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability and tumor mutational burden | Clinical notes |
| 0448U | Oncology (lung and colon cancer), DNA, qualitative, next-generation sequencing detection of single-nucleotide variants and deletions in EGFR and KRAS genes, formalin-fixed paraffin-embedded (FFPE) solid tumor samples, reported as presence or absence of targeted mutation(s), with recommended therapeutic options | Diagnostic/Imaging Report |
| 0450U | Oncology (multiple myeloma), liquid chromatography with tandem mass spectrometry (lc-ms/ms), monoclonal paraprotein sequencing analysis, serum, results reported as baseline presence or absence of detectable clonotypic peptides | Clinical notes |
| 0451U | Oncology (multiple myeloma), lc-ms/ms, peptide ion quantification, serum, results compared with baseline to determine monoclonal paraprotein abundance | Clinical notes |
| 0452U | Oncology (bladder), methylated penk dna detection by linear target enrichment-quantitative methylation-specific real-time pcr (lte-qmsp), urine, reported as likelihood of bladder cancer | Clinical notes |
| 0453U | Oncology (colorectal cancer), cell-free dna (cfdna), methylation-based quantitative pcr assay (septin9, ikzf1, bcat1, septin9-2, vav3, bcan), plasma, reported as presence or absence of circulating tumor dna (ctdna) | Clinical notes |
| 0454U | Rare diseases (constitutional/heritable disorders), identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping | Clinical notes |
| 0455U | Infectious agents (sexually transmitted infection), chlamydia trachomatis, neisseria gonorrhoeae, and trichomonas vaginalis, multiplex amplified probe technique, vaginal, endocervical, gynecological specimens, oropharyngeal swabs, rectal swabs, female or male urine, each pathogen reported as detected or not detected | Clinical notes |
| 0456U | Autoimmune (rheumatoid arthritis), next-generation sequencing (ngs), gene expression testing of 19 genes, whole blood, with analysis of anti-cyclic citrullinated peptides (ccp) levels, combined with sex, patient global assessment, and body mass index (bmi), algorithm reported as a score that predicts nonresponse to tumor necrosis factor inhibitor (tnfi) therapy | Clinical notes |
| 0457U | Perfluoroalkyl substances (pfas) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), 9 pfas compounds by lc-ms/ms, plasma or serum, quantitative | Clinical notes |
| 0458U | Oncology (breast cancer), s100a8 and s100a9, by enzyme-linked immunosorbent assay (elisa), tear fluid with age, algorithm reported as a risk score | Clinical notes |
| 0459U | Amyloid (abeta42) and total tau (ttau), electrochemiluminescent immunoassay (eclia), cerebral spinal fluid, ratio reported as positive or negative for amyloid pathology | Clinical notes |
| 0460U | Oncology, whole blood or buccal, dna single-nucleotide polymorphism (snp) genotyping by real-time pcr of 24 genes, with variant analysis and reported phenotypes | Clinical notes |
| 0461U | Oncology, pharmacogenomic analysis of single-nucleotide polymorphism (snp) genotyping by real-time pcr of 24 genes, whole blood or buccal swab, with variant analysis, including impacted gene-drug interactions and reported phenotypes | Clinical notes |
| 0462U | Melatonin levels test, sleep study, 7 or 9 sample melatonin profile (cortisol optional), enzyme-linked immunosorbent assay (elisa), saliva, screening/preliminary | Clinical notes |
| 0463U | Oncology (cervix), mrna gene expression profiling of 14 biomarkers (e6 and e7 of the highest-risk human papillomavirus [hpv] types 16, 18, 31, 33, 45, 52, 58), by real-time nucleic acid sequence-based amplification (nasba), exo- or endocervical epithelial cells, algorithm reported as positive or negative for increased risk of cervical dysplasia or cancer for each biomarker | Clinical notes |
| 0465U | Oncology (urothelial carcinoma), dna, quantitative methylation-specific pcr of 2 genes (onecut2, vim), algorithmic analysis reported as positive or negative | Clinical notes |
| 0466U | Cardiology (coronary artery disease [cad]), dna, genome-wide association studies (564856 single-nucleotide polymorphisms [snps], targeted variant genotyping), patient lifestyle and clinical data, buccal swab, algorithm reported as polygenic risk to acquired heart disease | Clinical notes |
| 0467U | Oncology (bladder), dna, next-generation sequencing (ngs) of 60 genes and whole genome aneuploidy, urine, algorithms reported as minimal residual disease (mrd) status positive or negative and quantitative disease burden | Clinical notes |
| 0468U | Hepatology (nonalcoholic steatohepatitis [nash]), mir-34a-5p, alpha 2-macroglobulin, ykl40, hba1c, serum and whole blood, algorithm reported as a single score for nash activity and fibrosis | Clinical notes |
| 0469U | Rare diseases (constitutional/heritable disorders), whole genome sequence analysis for chromosomal abnormalities, copy number variants, duplications/deletions, inversions, unbalanced translocations, regions of homozygosity (roh), inheritance pattern that performed, as comparators and/or maternal cell contamination indicate uniparental disomy (upd), and aneuploidy, fetal sample (amniotic fluid, chorionic villus sample, or products of conception), identification and categorization of genetic variants, diagnostic report of fetal results based on phenotype with maternal sample and paternal sample, if | Clinical notes |
| 0470U | Oncology (oropharyngeal), detection of minimal residual disease by next-generation sequencing (ngs) based quantitative evaluation of 8 dna targets, cell-free hpv 16 and 18 dna from plasma | Clinical notes |
| 0471U | Oncology (colorectal cancer), qualitative real-time pcr of 35 variants of kras and nras genes (exons 2, 3, 4), formalin-fixed paraffin-embedded (ffpe), predictive, identification of detected mutations | Clinical notes |
| 0472U | Carbonic anhydrase vi (ca vi), parotid specific/secretory protein (psp) and salivary protein (sp1) igg, igm, and iga antibodies, enzyme-linked immunosorbent assay (elisa), semiqualitative, blood, reported as predictive evidence of early sjögren syndrome | Clinical notes |
| 0473U | Oncology (solid tumor), next-generation sequencing (ngs) of dna from formalin-fixed paraffin-embedded (ffpe) tissue with comparative sequence analysis from a matched normal specimen (blood or saliva), 648 genes, interrogation for sequence variants, insertion and deletion alterations, copy number variants, rearrangements, microsatellite instability, and tumor-mutation burden | Clinical notes |
| 0474U | Hereditary pan-cancer (eg, hereditary sarcomas, hereditary endocrine tumors, hereditary neuroendocrine tumors, hereditary cutaneous melanoma), genomic sequence analysis panel of 88 genes with 20 duplications/deletions using next-generation sequencing (ngs), sanger sequencing, blood or saliva, reported as positive or negative for germline variants, each gene | Clinical notes |
| 0475U | Hereditary prostate cancer-related disorders, genomic sequence analysis panel using next-generation sequencing (ngs), sanger sequencing, multiplex ligation-dependent probe amplification (mlpa), and array comparative genomic hybridization (cgh), evaluation of 23 genes and duplications/deletions when indicated, pathologic mutations reported with a genetic risk score for prostate cancer | |
| 0476U | Drug metabolism, psychiatry (eg, major depressive disorder, general anxiety disorder, attention deficit hyperactivity disorder [ADHD], schizophrenia), whole blood, buccal swab, and pharmacogenomic genotyping of 14 genes and CYP2D6 copy number variant analysis and reported phenotypes | Clinical notes |
| 0477U | Drug metabolism, psychiatry (eg, major depressive disorder, general anxiety disorder, attention deficit hyperactivity disorder [ADHD], schizophrenia), whole blood, buccal swab, and pharmacogenomic genotyping of 14 genes and CYP2D6 copy number variant analysis, including impacted gene-drug interactions and reported phenotypes | Clinical notes |
| 0478U | Oncology (non-small cell lung cancer), DNA and RNA, digital PCR analysis of 9 genes (EGFR, KRAS, BRAF, ALK, ROS1, RET, NTRK 1/2/3, ERBB2, and MET) in formalin-fixed paraffin-embedded (FFPE) tissue, interrogation for single-nucleotide variants, insertions/deletions, gene rearrangements, and reported as actionable detected variants for therapy selection | Clinical notes |
| 0479U | Tau, phosphorylated, pTau217 | Clinical notes |
| 0480U | Infectious disease (bacteria, viruses, fungi, and parasites), cerebrospinal fluid (CSF), metagenomic next-generation sequencing (DNA and RNA), bioinformatic analysis, with positive pathogen identification | Clinical notes |
| 0481U | IDH1 (isocitrate dehydrogenase 1 [NADP+]), IDH2 (isocitrate dehydrogenase 2 [NADP+]), and TERT (telomerase reverse transcriptase) promoter (eg, central nervous system [CNS] tumors), next-generation sequencing (single-nucleotide variants [SNV], deletions, and insertions) | Clinical notes |
| 0482U | Obstetrics (preeclampsia), biochemical assay of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), serum, ratio reported for sFlt-1/PlGF, with risk of progression for preeclampsia with severe features within 2 weeks | Clinical notes |
| 0483U | Infectious disease (Neisseria gonorrhoeae), sensitivity, ciprofloxacin resistance (gyrA S91F point mutation), oral, rectal, or vaginal swab, algorithm reported as probability of fluoroquinolone resistance | Clinical notes |
| 0484U | Infectious disease (Mycoplasma genitalium), macrolide sensitivity (23S rRNA point mutation), oral, rectal, or vaginal swab, algorithm reported as probability of macrolide resistance | Clinical notes |
| 0485U | Oncology (solid tumor), cell-free DNA and RNA by next-generation sequencing, interpretative report for germline mutations, clonal hematopoiesis of indeterminate potential, and tumor-derived single-nucleotide variants, small insertions/deletions, copy number alterations, fusions, microsatellite instability, and tumor mutational burden | Clinical notes |
| 0486U | Oncology (pan-solid tumor), next-generation sequencing analysis of tumor methylation markers present in cell-free circulating tumor DNA, algorithm reported as quantitative measurement of methylation as a correlate of tumor fraction | Clinical notes |
| 0487U | Oncology (solid tumor), cell-free circulating DNA, targeted genomic sequence analysis panel of 84 genes, interrogation for sequence variants, aneuploidy-corrected gene copy number amplifications and losses, gene rearrangements, and microsatellite instability | Clinical notes |
| 0488U | Obstetrics (fetal antigen noninvasive prenatal test), cell-free DNA sequence analysis for detection of fetal presence or absence of 1 or more of the Rh, C, c, D, E, Duffy (Fya), or Kell (K) antigen in alloimmunized pregnancies, reported as selected antigen(s) detected or not detected | Clinical notes |
| 0489U | Obstetrics (single-gene noninvasive prenatal test), cell-free DNA sequence analysis of 1 or more targets (eg, CFTR, SMN1, HBB, HBA1, HBA2) to identify paternally inherited pathogenic variants, and relative mutation-dosage analysis based on molecular counts to determine fetal inheritance of maternal mutation, algorithm reported as a fetal risk score for the condition (eg, cystic fibrosis, spinal muscular atrophy, beta hemoglobinopathies [including sickle cell disease], alpha thalassemia) | Clinical notes |
| 0490U | Oncology (cutaneous or uveal melanoma), circulating tumor cell selection, morphological characterization and enumeration based on differential CD146, high molecular–weight melanoma-associated antigen, CD34 and CD45 protein biomarkers, peripheral blood | Clinical notes |
| 0491U | Oncology (solid tumor), circulating tumor cell selection, morphological characterization and enumeration based on differential epithelial cell adhesion molecule (EpCAM), cytokeratins 8, 18, and 19, CD45 protein biomarkers, and quantification of estrogen receptor (ER) protein biomarker–expressing cells, peripheral blood | Clinical notes |
| 0492U | Oncology (solid tumor), circulating tumor cell selection, morphological characterization and enumeration based on differential epithelial cell adhesion molecule (EpCAM), cytokeratins 8, 18, and 19, CD45 protein biomarkers, and quantification of PD-L1 protein biomarker–expressing cells, peripheral blood | Clinical notes |
| 0493U | Transplantation medicine, quantification of donor-derived cell-free DNA (cfDNA) using next-generation sequencing, plasma, reported as percentage of donor-derived cell-free DNA | Clinical notes |
| 0494U | Red blood cell antigen (fetal RhD gene analysis), next-generation sequencing of circulating cell-free DNA (cfDNA) of blood in pregnant individuals known to be RhD negative, reported as positive or negative | Clinical notes |
| 0495U | Oncology (prostate), analysis of circulating plasma proteins (tPSA, fPSA, KLK2, PSP94, and GDF15), germline polygenic risk score (60 variants), clinical information (age, family history of prostate cancer, prior negative prostate biopsy), algorithm reported as risk of likelihood of detecting clinically significant prostate cancer | Clinical notes |
| 0496U | Oncology (colorectal), cell-free DNA, 8 genes for mutations, 7 genes for methylation by real-time RT-PCR, and 4 proteins by enzyme-linked immunosorbent assay, blood, reported positive or negative for colorectal cancer or advanced adenoma risk | Clinical notes |
| 0497U | Oncology (prostate), mRNA gene-expression profiling by real-time RT-PCR of 6 genes (FOXM1, MCM3, MTUS1, TTC21B, ALAS1, and PPP2CA), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a risk score for prostate cancer | Clinical notes |
| 0498U | Oncology (colorectal), next-generation sequencing for mutation detection in 43 genes and methylation pattern in 45 genes, blood, and formalin-fixed paraffin-embedded (FFPE) tissue, report of variants and methylation pattern with interpretation | Clinical notes |
| 0499U | Oncology (colorectal and lung), DNA from formalin-fixed paraffin-embedded (FFPE) tissue, next-generation sequencing of 8 genes (NRAS, EGFR, CTNNB1, PIK3CA, APC, BRAF, KRAS, and TP53), mutation detection | Clinical notes |
| 0500U | Autoinflammatory disease (VEXAS syndrome), DNA, UBA1 gene mutations, targeted variant analysis (M41T, M41V, M41L, c.118-2A>C, c.118-1G>C, c.118-9_118-2del, S56F, S621C) | Clinical notes |
| 0501U | Oncology (colorectal), blood, quantitative measurement of cell-free DNA (cfDNA) | Clinical notes |
| 0502U | Human papillomavirus (HPV), E6/E7 markers for high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), cervical cells, branched-chain capture hybridization, reported as negative or positive for high risk for HPV | Clinical notes |
| 0503U | Neurology (Alzheimer disease), beta amyloid (Aβ40, Aβ42, Aβ42/40 ratio) and tau-protein (ptau217, np-tau217, ptau217/np-tau217 ratio), blood, immunoprecipitation with quantitation by liquid chromatography with tandem mass spectrometry (LC-MS/MS), algorithm score reported as likelihood of positive or negative for amyloid plaques | Clinical notes |
| 0504U | Infectious disease (urinary tract infection), identification of 17 pathologic organisms, urine, real-time PCR, reported as positive or negative for each organism | Clinical notes |
| 0505U | Infectious disease (vaginal infection), identification of 32 pathogenic organisms, swab, real-time PCR, reported as positive or negative for each organism | Clinical notes |
| 0506U | Gastroenterology (Barrett’s esophagus), esophageal cells, DNA methylation analysis by next-generation sequencing of at least 89 differentially methylated genomic regions, algorithm reported as likelihood for Barrett’s esophagus | Clinical notes |
| 0507U | Oncology (ovarian), DNA, whole-genome sequencing with 5-hydroxymethylcytosine (5hmC) enrichment, using whole blood or plasma, algorithm reported as cancer detected or not detected | Clinical notes |
| 0508U | Transplantation medicine, quantification of donor-derived cell-free DNA using 40 single-nucleotide polymorphisms (SNPs), plasma, and urine, initial evaluation reported as percentage of donor-derived cell-free DNA with risk for active rejection | Clinical notes |
| 0509U | Transplantation medicine, quantification of donor-derived cell-free DNA using up to 12 single-nucleotide polymorphisms (SNPs) previously identified, plasma, reported as percentage of donor-derived cell-free DNA with risk for active rejection | Clinical notes |
| 0510U | Oncology (pancreatic cancer), augmentative algorithmic analysis of 16 genes from previously sequenced RNA whole-transcriptome data, reported as probability of predicted molecular subtype | Clinical notes |
| 0511U | Oncology (solid tumor), tumor cell culture in 3D microenvironment, 36 or more drug panel, reported as tumor-response prediction for each drug | Clinical notes |
| 0512U | Oncology (prostate), augmentative algorithmic analysis of digitized whole-slide imaging of histologic features for microsatellite instability (MSI) status, formalin-fixed paraffin-embedded (FFPE) tissue, reported as increased or decreased probability of MSI-high (MSI-H) | Clinical notes |
| 0513U | Oncology (prostate), augmentative algorithmic analysis of digitized whole-slide imaging of histologic features for microsatellite instability (MSI) and homologous recombination deficiency (HRD) status, formalin-fixed paraffin-embedded (FFPE) tissue, reported as increased or decreased probability of each biomarker | Clinical notes |
| 0514U | Gastroenterology (irritable bowel disease [IBD]), immunoassay for quantitative determination of adalimumab (ADL) levels in venous serum in patients undergoing adalimumab therapy, results reported as a numerical value as micrograms per milliliter (μg/mL) | Clinical notes |
| 0515U | Gastroenterology (irritable bowel disease [IBD]), immunoassay for quantitative determination of infliximab (IFX) levels in venous serum in patients undergoing infliximab therapy, results reported as a numerical value as micrograms per milliliter (μg/mL) | Clinical notes |
| 0516U | Drug metabolism, whole blood, pharmacogenomic genotyping of 40 genes and CYP2D6 copy number variant analysis, reported as metabolizer status | Clinical notes |
| 0517U | Therapeutic drug monitoring, 80 or more psychoactive drugs or substances, LC-MS/MS, plasma, qualitative and quantitative therapeutic minimally and maximally effective dose of prescribed and non-prescribed medications | Clinical notes |
| 0518U | Therapeutic drug monitoring, 90 or more pain and mental health drugs or substances, LC-MS/MS, plasma, qualitative and quantitative therapeutic minimally effective range of prescribed and non-prescribed medications | Clinical notes |
| 0519U | Therapeutic drug monitoring, medications specific to pain, depression, and anxiety, LC-MS/MS, plasma, 110 or more drugs or substances, qualitative and quantitative therapeutic minimally effective range of prescribed, non-prescribed, and illicit medications in circulation | Clinical notes |
| 0520U | Therapeutic drug monitoring, 200 or more drugs or substances, LC-MS/MS, plasma, qualitative and quantitative therapeutic minimally effective range of prescribed and non-prescribed medications | Clinical notes |
| 0521U | Rheumatoid factor IgG and IgM, cyclic citrullinated peptide (CCP) antibodies, and scavenger receptor a (SR-A) by immunoassay, blood | Clinical Notes |
| 0523U | Oncology (solid tumor), DNA, qualitative, next-generation sequencing (NGS) of single- nucleotide variants (SNV) and insertion/deletions in 22 genes utilizing formalin-fixed paraffin- embedded tissue, reported as presence or absence of mutation(s), location of mutation(s), nucleotide change, and amino acid change | Clinical Notes |
| 0530U | Oncology (pan-solid tumor), CTDNA, utilizing plasma, next- generation sequencing (NGS) of 77 genes, 8 fusions, microsatellite instability, and tumor mutation burden, interpretative report for single-nucleotide variants, copy-, Number alterations, with therapy association | Clinical Notes |
| 0538U | Oncology (solid tumor), next generation targeted sequencing analysis, formalin-fixed paraffin embedded (FFPE) tumor tissue, DNA analysis of 600 genes, interrogation for single-nucleotide variants, insertions/deletions, gene rearrangements, and copy number | Clinical Notes |
| 0539U | Oncology (solid tumor), cell free circulating tumor DNA (ctDNA), 152 genes, next generation sequencing, interrogation for single nucleotide variants, insertions/deletions, gene rearrangements, copy number alterations, and microsatellite instability, using | Clinical Notes |
| 0540U | Transplantation medicine, quantification of donor derived cell-free DNA using next-generation sequencing analysis of plasma, reported as percentage of donor derived cell-free DNA to determine probability of rejection | Clinical Notes |
| 0543U | Oncology (solid tumor), next generation sequencing of DNA from formalin-fixed paraffin-embedded (FFPE) tissue of 517 genes, interrogation for single-nucleotide variants, multi nucleotide variants, insertions and deletions from DNA, fusions in 24 genes and | Clinical Notes |
| 0544U | Nephrology (transplant monitoring), 48 variants by digital PCR, using cell-free DNA from plasma donor-derived cell-free DNA, percentage reported as risk for rejection | Clinical Notes |
| 0552U | Reproductive medicine (preimplantation genetic assessment), analysis for known genetic disorders from trophectoderm biopsy, linkage analysis of disease-causing locus, and when possible, targeted mutation analysis for known familial variant, reported as low-risk or high-risk for familial genetic disorder | Clinical Notes |
| 0568U | Neurology (dementia), beta amyloid (aβ40, aβ42, aβ42/40 ratio), tau-protein phosphorylated at residue (e.g., ptau217), neurofilament light chain (NFL), and glial fibrillary acidic protein (GFAP), by ultra-high sensitivity molecule array detection, plasma, algorithm reported as positive, intermediate, or negative for Alzheimer pathology | Clinical Notes |
| 0570U | Neurology (traumatic brain injury), analysis of glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase l1 (UCH-L1), immunoassay, whole blood or plasma, individual components reported with the overall result of elevated or non-elevated based on threshold comparison | Clinical Notes |
| 0571U |
Oncology (solid tumor), DNA (80 genes) and RNA (10 genes), by next-generation sequencing, plasma, including single-nucleotide variants, insertions/ deletions, copy-number alterations, microsatellite instability, and fusions, reported as clinically actionable variants |
Clinical Notes |
| 0616U | Neurology (dementia), dna methylation analysis of more than 30,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0617U | Cardiovascular (atherosclerotic cardiovascular disease [ascvd]), dna methylation analysis of more than 20,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0618U | Psychiatry (bipolar disorder), dna methylation analysis of more than 10,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0619U | Pulmonary (chronic obstructive pulmonary disease [copd]), dna methylation analysis of more than 18,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0620U | Oncology (hepatocellular carcinoma), dna methylation analysis of more than 5,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0621U | Infectious disease (lyme borreliosis), dna methylation analysis of more than 10,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0622U | Psychiatry (major depressive disorder), dna methylation analysis of more than 20,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0623U | Autoimmune (multiple sclerosis), dna methylation analysis of more than 5,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0624U | Hepatology (nonalcoholic steatohepatitis [nash]), dna methylation analysis of 5,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0625U | Endocrinology (osteoporosis), dna methylation analysis of more than 5,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0626U | Neurology (parkinson disease), dna methylation analysis of more than 20,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0627U | Psychiatry (schizophrenia), dna methylation analysis of more than 15,000 sites, whole blood, algorithm reported as positive or negative risk | Clinical Notes |
| 0628U | Nephrology (kidney disease- related genetic conditions), genomic analysis, renal disease panel, saliva, dna, next-generation sequencing of 449 genes, reported as pathogenic or likely pathogenic variants of uncertain significance or risk alleles | Clinical Notes |
| 0630U | Oncology (breast), mrna, gene expression profiling by microarray of 80 genes (80 content and 465 housekeeping), utilizing formalin-fixed paraffin- embedded tissue (ffpe), algorithm reported as an index that is diagnostic of a molecular subtype (luminal, b | Clinical Notes |
| 80374 | Stereoisomer (enantiomer) analysis, single drug class | Clinical notes |
| 80500 | Clinical pathology consultation; limited, without review of patient’s history and medical records | Referring physician’s written request for consult and subsequent consultation report |
| 80502 | comprehensive, for a complex diagnostic problem, with review of patient’s history and medical records | Referring physician’s written request for consult and subsequent consultation report |
| 81105 | Human platelet antigen 1 genotyping (hpa-1), itgb3 (integrin, beta 3 [platelet glycoprotein iiia], antigen cd61 [gpiiia]) (eg, neonatal alloimmune thrombocytopenia [nait], post-transfusion purpura), gene analysis, common variant, hpa-1a/b (l33p) | Clinical notes |
| 81106 | Human platelet antigen 2 genotyping (hpa-2), gp1ba (glycoprotein ib [platelet], alpha polypeptide [gpiba]) (eg, neonatal alloimmune thrombocytopenia [nait], post-transfusion purpura), gene analysis, common variant, hpa-2a/b (t145m) | Clinical notes |
| 81107 | Human platelet antigen 3 genotyping (hpa-3), itga2b (integrin, alpha 2b [platelet glycoprotein iib of iib/iiia complex], antigen cd41 [gpiib]) (eg, neonatal alloimmune thrombocytopenia [nait], post-transfusion purpura), gene analysis, common variant, hpa | Clinical notes |
| 81108 | Human platelet antigen 4 genotyping (hpa-4), itgb3 (integrin, beta 3 [platelet glycoprotein iiia], antigen cd61 [gpiiia]) (eg, neonatal alloimmune thrombocytopenia [nait], post-transfusion purpura), gene analysis, common variant, hpa-4a/b (r143q) | Clinical notes |
| 81109 | Human platelet antigen 5 genotyping (hpa-5), itga2 (integrin, alpha 2 [cd49b, alpha 2 subunit of vla-2 receptor] [gpia]) (eg, neonatal alloimmune thrombocytopenia [nait], post-transfusion purpura), gene analysis, common variant (eg, hpa-5a/b (k505e)) | Clinical notes |
| 81110 | Human platelet antigen 6 genotyping (hpa-6w), itgb3 (integrin, beta 3 [platelet glycoprotein iiia, antigen cd61] [gpiiia]) (eg, neonatal alloimmune thrombocytopenia [nait], post-transfusion purpura), gene analysis, common variant, hpa-6a/b (r489q) | Clinical notes |
| 81111 | Human platelet antigen 9 genotyping (hpa-9w), itga2b (integrin, alpha 2b [platelet glycoprotein iib of iib/iiia complex, antigen cd41] [gpiib]) (eg, neonatal alloimmune thrombocytopenia [nait], post-transfusion purpura), gene analysis, common variant, hp | Clinical notes |
| 81112 | Human platelet antigen 15 genotyping (hpa-15), cd109 (cd109 molecule) (eg, neonatal alloimmune thrombocytopenia [nait], post-transfusion purpura), gene analysis, common variant, hpa-15a/b (s682y) | Clinical notes |
| 81174 | Ar (androgen receptor) (eg, spinal and bulbar muscular atrophy, kennedy disease, x chromosome inactivation) gene analysis; known familial variant | Clinical notes |
| 81186 | Cacna1a (calcium voltage-gated channel subunit alpha1 a) (eg, spinocerebellar ataxia) gene analysis; known familial variant | Clinical notes |
| 81195 | Cytogenomic (genome-wide) analysis, hematologic malignancy, structural variants and copy number variants, optical genome mapping (OGM) | Clinical notes |
| 81248 | G6pd (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; known familial variant(s) | Clinical notes |
| 81258 | Hba1/hba2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, hb bart hydrops fetalis syndrome, hbh disease), gene analysis; known familial variant | Clinical notes |
| 81261 | IGH (immunoglobulin heavy chain locus) (e.g., leukemias and lymphomas, B‐cell), gene rearrangement analysis to detect abnormal clonal population(s); amplified methodology (e.g., polymerase chain reaction) | Pend for clinical notes |
| 81263 | variable region somatic mutation analysis | Pend for clinical notes |
| 81264 | IGK (immunoglobulin kappa light chain locus) (e.g., leukemia and lymphoma, b‐cell), gene rearrangement analysis, evaluation to detect abnormal clonal population(s) | Pend for clinical notes |
| 81267 | Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; without cell selection | Clinical notes |
| 81268 | Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; with cell selection (eg, CD3, CD33), each cell type | Clinical notes |
| 81289 | Fxn (frataxin) (eg, friedreich ataxia) gene analysis; known familial variant(s) | Clinical notes |
| 81305 | Myd88 (myeloid differentiation primary response 88) (eg, waldenstrom's macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.leu265pro (l265p) variant | Clinical notes |
| 81332 | 81332 SERPINA1 (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin, member 1) (eg, alpha-1-antitrypsin deficiency), gene analysis, common variants (eg,*S and *Z) | Clinical notes |
| 81344 | Tbp (tata box binding protein) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | Clinical notes |
| 81362 | Hbb (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); known familial variant(s) | Clinical notes |
| 81370 | HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, -C, -DRB1/3/4/5, and -DQB1 | Clinical notes |
| 81371 | HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, and -DRB1 (eg, verification typing) | Clinical notes |
| 81372 | HLA Class I typing, low resolution (eg, antigen equivalents); complete (ie, HLA-A, -B, and -C) | Clinical notes |
| 81373 | HLA Class I typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-A, -B, or -C), each | Clinical notes |
| 81375 | HLA Class II typing, low resolution (eg, antigen equivalents); HLA-DRB1/3/4/5 and -DQB1 | Clinical notes |
| 81376 | HLA Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each | Clinical notes |
| 81378 | HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA-A, -B, -C, and -DRB1 | Clinical notes |
| 81379 | HLA Class I typing, high resolution (ie, alleles or allele groups); complete (ie, HLA-A, -B, and -C) | Clinical notes |
| 81380 | HLA Class I typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA-A, -B, or -C), each | Clinical notes |
| 81381 | HLA Class I typing, high resolution (ie, alleles or allele groups); one allele or allele group (eg, B*57:01P), each | Clinical notes |
| 81382 | HLA Class II typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each | Clinical notes |
| 81383 | HLA Class II typing, high resolution (ie, alleles or allele groups); one allele or allele group (eg, HLA-DQB1*06:02P), each | Clinical notes |
| 81425 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis | Clinical notes |
| 81426 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genome (eg, parents, siblings) (list separately in addition to code for primary procedure) | Clinical notes |
| 81427 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); re-evaluation of previously obtained genome sequence (eg, updated knowledge or unrelated condition/syndrome) | Clinical notes |
| 81441 | Inherited bone marrow failure syndromes (ibmfs) (eg, fanconi anemia, dyskeratosis congenita, diamond-blackfan anemia, shwachman-diamond syndrome, gata2 deficiency syndrome, congenital amegakaryocytic thrombocytopenia) sequence analysis panel, must include sequencing of at least 30 genes, including brca2, brip1, dkc1, fanca, fancb, fancc, fancd2, fance, fancf, fancg, fanci, fancl, gata1, gata2, mpl, nhp2, nop10, palb2, rad51c, rpl11, rpl35a, rpl5, rps10, rps19, rps24, rps26, rps7, sbds, tert, and tinf2 | Clinical notes |
| 81457 | SOLID ORGAN NEOPLASM, GENOMIC SEQUENCE ANALYSIS PANEL, INTERROGATION FOR SEQUENCE VARIANTS; DNA ANALYSIS, MICROSATELLITE INSTABILITY | Clinical notes |
| 81458 | SOLID ORGAN NEOPLASM, GENOMIC SEQUENCE ANALYSIS PANEL, INTERROGATION FOR SEQUENCE VARIANTS; DNA ANALYSIS, COPY NUMBER VARIANTS AND MICROSATELLITE INSTABILITY | Clinical notes |
| 81459 | SOLID ORGAN NEOPLASM, GENOMIC SEQUENCE ANALYSIS PANEL, INTERROGATION FOR SEQUENCE VARIANTS; DNA ANALYSIS OR COMBINED DNA AND RNA ANALYSIS, COPY NUMBER VARIANTS, MICROSATELLITE INSTABILITY, TUMOR MUTATION BURDEN, AND REARRANGEMENTS | Clinical notes |
| 81462 | SOLID ORGAN NEOPLASM, GENOMIC SEQUENCE ANALYSIS PANEL, CELL-FREE NUCLEIC ACID (EG, PLASMA), INTERROGATION FOR SEQUENCE VARIANTS; DNA ANALYSIS OR COMBINED DNA AND RNA ANALYSIS, COPY NUMBER VARIANTS AND REARRANGEMENTS | Clinical notes |
| 81463 | SOLID ORGAN NEOPLASM, GENOMIC SEQUENCE ANALYSIS PANEL, CELL-FREE NUCLEIC ACID (EG, PLASMA), INTERROGATION FOR SEQUENCE VARIANTS; DNA ANALYSIS, COPY NUMBER VARIANTS, AND MICROSATELLITE INSTABILITY | Clinical notes |
| 81464 | SOLID ORGAN NEOPLASM, GENOMIC SEQUENCE ANALYSIS PANEL, CELL-FREE NUCLEIC ACID (EG, PLASMA), INTERROGATION FOR SEQUENCE VARIANTS; DNA ANALYSIS OR COMBINED DNA AND RNA ANALYSIS, COPY NUMBER VARIANTS, MICROSATELLITE INSTABILITY, TUMOR MUTATION BURDEN, AND REARRANGEMENTS | Clinical notes |
| 81509 | Fetal congenital abnormalities, biochemical assays of three proteins (PAPP-A, hCG [any form], DIA), utilizing maternal serum, algorithm reported as a risk score | Clinical notes |
| 81510 | Fetal congenital abnormalities, biochemical assays of three analytes (AFP, uE3, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score | Clinical notes |
| 81511 | Fetal congenital abnormalities, biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) utilizing maternal serum, algorithm reported as a risk score (may include additional results from previous biochemical testing) | Clinical notes |
| 81512 | Fetal congenital abnormalities, biochemical assays of five analytes (AFP, uE3, total hCG, hyperglycosylated hCG, DIA) utilizing maternal serum, algorithm reported as a risk score | Clinical notes |
| 86362 | Myelin Oligodendrocyte Glycoprotein (Mog-Igg1) Antibody; Cell-Based Immunofluorescence Assay (Cba), Each | Clinical notes |
| 88230 | Tissue culture for non‐neoplastic disorders; lymphocyte | Pend for clinical notes |
| 88233 | skin or other solid tissue biopsy | Pend for clinical notes |
| 88237 | Tissue culture for neoplastic disorders; bone marrow, blood cells | Pend for clinical notes |
| 88239 | Tissue culture for neoplastic disorders; solid tumor | Clinical notes |
| 88272 | chromosomal in situ hybridization, analyze 3‐5 cells (e.g., for derivatives and markers) | Pend for clinical notes |
| 88749 | Unlisted in vivo (eg transcutaneous) laboratory service | Pathology report |
| 92618 | Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure) | Clinical notes |
| 93998 | Unlisted noninvasive vascular diagnostic study | Clinical notes |
| G0659 | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (eg, ia, eia, elisa, emit, fpia) and enzymatic methods (eg, alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes | Clinical notes |
| G6035 | Gold | Clinical notes |
| S3841 | Genetic testing for retinoblastoma | Clinical notes |
| S3842 | Genetic testing for Von Hippel-Lindau disease | Clinical notes |
| S3850 | Genetic testing for sickle cell anemia | Clinical notes |
| S3853 | Genetic testing for myotonic muscular dystrophy | Clinical notes |
In addition, HMSA may require submission of clinical records before or after payment of claims for the purpose of investigating potential fraudulent, abusive or other inappropriate billing practices, but only as long as there is a reasonable basis for believing such investigation is warranted.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform.
|