How To Use CPT Code 0055U

CPT 0055U describes a proprietary laboratory analysis (PLA) code for a specific lab test called myTAIHEART™ by TAI Diagnostics, Inc. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0055U.

1. What is CPT Code 0055U?

CPT 0055U is a unique PLA code that applies to a specific lab test called myTAIHEART™. This test, developed by TAI Diagnostics, Inc., utilizes PCR technology in conjunction with standard clinical assessment to determine the likelihood of rejection in heart transplant recipients. By analyzing cell-free DNA (cfDNA) in the recipient’s plasma, the test measures the risk of transplanted organ injury and provides valuable information for clinicians to plan appropriate treatment.

2. Official Description

The official description of CPT code 0055U is: ‘Cardiology (heart transplant), cell-free DNA, PCR assay of 96 DNA target sequences (94 single nucleotide polymorphism targets and two control targets), plasma.’

3. Procedure

1. After initial genotyping of the donor heart and the recipient, the lab analyst uses a proprietary PCR genotyping technology to isolate and quantify the amount of circulating cell-free DNA (cfDNA) from the recipient’s plasma.
2. The analyst measures the activity of a total of 96 DNA target sequences, including 94 single nucleotide polymorphism targets and two control targets, using PCR technology.
3. The process distinguishes between the cfDNA from the donor heart and the cfDNA from the recipient, reporting the ratio as a measure of the risk of rejection.

4. Qualifying circumstances

CPT code 0055U is applicable for heart transplant recipients who require an assessment of the likelihood of rejection. The test analyzes cell-free DNA in the recipient’s plasma to identify transplanted organ injury. Clinicians order this test to predict the risk of rejection and plan appropriate treatment strategies for their patients.

5. When to use CPT code 0055U

CPT code 0055U should be used specifically for the myTAIHEART™ laboratory test by TAI Diagnostics, Inc. It is important to note that this code is a proprietary laboratory analysis (PLA) code and should not be reported with any other CPT codes. Only report one unit of this code for a single specimen analyzed on a single date of service.

6. Documentation requirements

To support a claim for CPT code 0055U, the following documentation is required:

• Documentation of the clinical need for the test, including the recipient’s status as a heart transplant recipient and the need for an assessment of the likelihood of rejection.
• Documentation of the specific test performed, including the use of PCR technology to analyze 96 DNA target sequences.
• Date of service and details of the specimen analyzed.
• Results of the test, including the ratio of cfDNA from the donor heart to cfDNA from the recipient.
• Signature of the lab analyst performing the test.

7. Billing guidelines

When billing for CPT code 0055U, ensure that the test is performed by TAI Diagnostics, Inc. and that the appropriate documentation is provided. This code should not be reported with any other CPT codes. Some payers may separately reimburse for the collection of the specimen, so it is advisable to check with the appropriate payer for their specific requirements.

8. Historical information

CPT code 0055U was added to the Current Procedural Terminology system on July 1, 2018. There have been no updates or changes to the code since its addition.

9. Examples

1. A heart transplant recipient undergoes the myTAIHEART™ test to assess the risk of rejection and determine appropriate treatment.
2. A cardiologist orders the myTAIHEART™ test for a patient who recently received a heart transplant to monitor their likelihood of rejection.
3. A transplant surgeon utilizes the myTAIHEART™ test results to make informed decisions about immunosuppressive therapy for a heart transplant recipient.
4. A heart transplant recipient undergoes regular myTAIHEART™ testing to track changes in the risk of rejection over time.
5. A transplant team uses the myTAIHEART™ test to guide post-transplant care and optimize outcomes for heart transplant recipients.
6. A heart transplant recipient’s myTAIHEART™ test results indicate a low risk of rejection, allowing for adjustments in their treatment plan.
7. A patient who received a heart transplant several years ago undergoes the myTAIHEART™ test as part of routine monitoring for potential rejection.
8. A cardiologist orders the myTAIHEART™ test to assess the risk of rejection in a heart transplant recipient experiencing unexplained symptoms.
9. A heart transplant recipient’s myTAIHEART™ test results indicate a high risk of rejection, prompting immediate intervention and adjustment of their treatment plan.
10. A transplant team utilizes the myTAIHEART™ test to evaluate the effectiveness of immunosuppressive therapy in preventing rejection in heart transplant recipients.