How To Use CPT Code 0096U

CPT 0096U describes a specific proprietary laboratory analysis (PLA) test for the detection of high-risk types of human papillomavirus (HPV) in male urine specimens. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0096U.

1. What is CPT Code 0096U?

CPT 0096U is a unique code that represents a proprietary laboratory analysis (PLA) test for the detection of high-risk HPV types in male urine specimens. This test is specifically designed to identify 14 high-risk HPV genotypes, including types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. It is important to note that this code applies to a specific test offered by Molecular Testing Labs, Roche Cobas®, which utilizes an automated PCR method for accurate and efficient detection of these HPV genotypes.

2. Official Description

The official description of CPT code 0096U is: ‘Human papillomavirus (HPV), high-risk types (i.e., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68), male urine.’

3. Procedure

1. The laboratory analyst receives a male urine specimen for HPV testing.
2. The specimen and reagents are prepared and loaded into the automated PCR instrument, Roche Cobas®.
3. The instrument performs the necessary amplification of target DNA and nucleic acid hybridization for the detection of the 14 high-risk HPV genotypes.
4. The algorithmic software generates results for both pooled high-risk HPV genotypes (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68) and individual results for the highest-risk genotypes (16 and 18).
5. The laboratory analyst reviews and interprets the results, providing a comprehensive report to the ordering clinician.

4. Qualifying Circumstances

CPT code 0096U is applicable for male patients suspected of having HPV. The test is specifically designed to detect high-risk HPV genotypes in urine specimens. It is important to note that this code is limited to the proprietary test offered by Molecular Testing Labs, Roche Cobas®, and should not be used for other HPV tests or specimen types.

5. When to Use CPT Code 0096U

CPT code 0096U should be used when a male patient requires testing for high-risk HPV genotypes using a urine specimen. This code is specific to the automated PCR test offered by Molecular Testing Labs, Roche Cobas®. It is important to ensure that the test is medically necessary and ordered by a clinician for the appropriate patient population.

6. Documentation Requirements

To support a claim for CPT code 0096U, the following documentation is required:

• Order from the clinician requesting the HPV test on a male urine specimen
• Date of service when the specimen was collected
• Results of the HPV test, including the specific high-risk genotypes detected
• Interpretation of the results by the laboratory analyst
• Signature of the laboratory analyst performing the test

7. Billing Guidelines

When billing for CPT code 0096U, ensure that the test is performed by Molecular Testing Labs, Roche Cobas®, and that the test is conducted on a male urine specimen. It is important to follow the specific guidelines provided by the payer regarding the appropriate use of PLA codes and any additional documentation requirements. Do not report CPT code 0096U with any other HPV test codes or for specimens other than male urine.

8. Historical Information

CPT code 0096U is a proprietary laboratory analysis (PLA) code that was introduced to the Current Procedural Terminology system. This code represents the high-risk HPV test on male urine specimens using the Molecular Testing Labs, Roche Cobas® automated PCR test. There have been no updates or changes to this code since its introduction.

9. Examples

1. A clinician orders CPT code 0096U for a male patient with suspected high-risk HPV infection based on clinical symptoms and risk factors.
2. A laboratory analyst performs the Roche Cobas® HPV test on a male urine specimen, detecting high-risk genotypes 16, 18, 31, and 58.
3. CPT code 0096U is billed for a male patient who presents with persistent HPV-related symptoms and requires further evaluation.
4. A clinician orders CPT code 0096U for a male patient with a history of high-risk sexual behavior and potential HPV exposure.
5. The Roche Cobas® HPV test on a male urine specimen detects high-risk genotypes 45, 51, and 66, and CPT code 0096U is reported for billing purposes.
6. A laboratory analyst interprets the results of the Roche Cobas® HPV test on a male urine specimen, indicating the presence of high-risk genotypes 39, 52, and 68.
7. CPT code 0096U is used for a male patient who requires HPV testing as part of routine screening for sexually transmitted infections.
8. A clinician orders CPT code 0096U for a male patient with persistent abnormal findings on previous HPV tests.
9. The Roche Cobas® HPV test on a male urine specimen detects high-risk genotypes 33, 35, and 59, and CPT code 0096U is billed accordingly.
10. A laboratory analyst performs the HPV test on a male urine specimen using the Roche Cobas® system, detecting high-risk genotypes 56 and 68, and CPT code 0096U is reported for reimbursement.