How To Use CPT Code 0226U

CPT 0226U describes a proprietary laboratory analysis (PLA) code for the surrogate viral neutralization test (sVNT) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as the coronavirus disease (COVID-19). This article will provide an overview of CPT 0226U, including its official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0226U?

CPT 0226U is a proprietary laboratory analysis (PLA) code that specifically applies to the Tru-ImmuneTM test offered by Ethos Laboratories from GenScript® USA. This test is designed to identify the current neutralizing capacity of antibodies against the SARS-CoV-2 virus in a blood sample. It helps determine the patient’s current level of protection and ability to fight the virus.

2. Official Description

The official description of CPT code 0226U is: ‘Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), ELISA, plasma, serum.’

3. Procedure

1. The lab analyst receives a blood sample from an individual and processes it for a multistep-blocking ELISA assay using the Tru-ImmuneTM test.
2. The surrogate viral neutralization test (sVNT) detects and evaluates the effectiveness of SARS-CoV-2 neutralizing antibodies in the specimen, indicating the body’s current capacity to fight against the virus.
3. The laboratory professional studies the absorbance and interprets the findings to determine the patient’s SARS-CoV-2 inhibition ability.
4. A report on the patient’s SARS-CoV-2 inhibition ability is sent to the ordering clinician.

4. Qualifying circumstances

CPT 0226U is typically ordered for patients with a history of COVID-19 or respiratory infection symptoms to detect past exposure to the SARS-CoV-2 virus. It is also used to measure the patient’s current level of protection and ability to fight the virus. Additionally, it may be used for screening potential blood plasma donors to treat current COVID-19 patients.

5. When to use CPT code 0226U

CPT code 0226U should be used when ordering the Tru-ImmuneTM test to identify the current neutralizing capacity of antibodies against the SARS-CoV-2 virus. It should only be reported for a single specimen analyzed on a single date of service.

6. Documentation requirements

To support a claim for CPT 0226U, the documentation should include:

• Patient’s history of COVID-19 or respiratory infection symptoms
• Specific test performed (Tru-ImmuneTM)
• Date of service
• Results and interpretation of the surrogate viral neutralization test
• Signature of the laboratory professional

7. Billing guidelines

When billing for CPT 0226U, report one unit of this code for a single specimen analyzed on a single date of service. Some payers may separately reimburse for specimen collection using a code such as 36415. It is important to use this code only for the Tru-ImmuneTM test and not report it using any other CPT code.

8. Historical information

CPT 0226U, the surrogate viral neutralization test for SARS-CoV-2, was added to the Current Procedural Terminology system on August 10, 2020. There have been no updates to the code since its addition.

9. Examples

1. A clinician orders the Tru-ImmuneTM test for a patient with a history of COVID-19 to assess their current level of protection against the SARS-CoV-2 virus.
2. A patient presents with respiratory infection symptoms, and the clinician orders the Tru-ImmuneTM test to determine if they have been exposed to the SARS-CoV-2 virus.
3. A healthcare facility screens potential blood plasma donors using the Tru-ImmuneTM test to identify individuals with high levels of neutralizing antibodies against the SARS-CoV-2 virus.
4. A patient who has recovered from COVID-19 undergoes the Tru-ImmuneTM test to assess their current level of protection against reinfection.
5. A clinician orders the Tru-ImmuneTM test for a patient with a compromised immune system to evaluate their ability to fight against the SARS-CoV-2 virus.
6. A healthcare provider utilizes the Tru-ImmuneTM test to monitor the neutralizing antibody levels in a patient receiving convalescent plasma therapy for COVID-19.
7. A patient with respiratory symptoms undergoes the Tru-ImmuneTM test to determine if their symptoms are caused by the SARS-CoV-2 virus.
8. A clinician orders the Tru-ImmuneTM test for a patient who has been in close contact with a confirmed COVID-19 case to assess their risk of infection.
9. A healthcare facility uses the Tru-ImmuneTM test to screen individuals before allowing them to enter high-risk settings, such as nursing homes or hospitals.
10. A patient with a history of COVID-19 undergoes the Tru-ImmuneTM test to assess the longevity of their neutralizing antibodies against the SARS-CoV-2 virus.