How To Use CPT Code 0241U

CPT 0241U describes a proprietary laboratory analysis (PLA) test for the detection of viral respiratory tract infections. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0241U?

CPT 0241U is a unique code that represents a specific laboratory test called Xpert® Xpress SARS–CoV–2/Flu/RSV. This test is designed to rapidly detect and differentiate between severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A and B viruses, and respiratory syncytial virus (RSV) in upper respiratory specimens. It provides valuable information for clinicians in diagnosing respiratory viral infections.

2. Official Description

The official description of CPT code 0241U is: ‘Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected.’

3. Procedure

1. The laboratory analyst receives an upper respiratory specimen, typically obtained through a nasopharyngeal swab, nasal swab, or nasal wash.
2. The specimen is mixed and transferred to the sample chamber of the Xpert® Xpress SARS–CoV–2/Flu/RSV cartridge.
3. The cartridge is loaded onto the platform for automated sample processing and real-time reverse transcription polymerase chain reaction (RT-PCR) analysis.
4. The test detects the presence or absence of four viral targets: SARS–CoV–2, influenza A, influenza B, and RSV.
5. The results are generated within approximately 30-40 minutes, indicating whether each pathogen is detected or not detected in the specimen.

4. Qualifying circumstances

CPT 0241U is used for patients suspected of having a viral respiratory tract infection, such as COVID-19, influenza, or RSV. The test is performed on upper respiratory specimens, which are collected from the nasopharynx or nasal cavity. It is important to note that this code specifically applies to the Xpert® Xpress SARS–CoV–2/Flu/RSV test from Cepheid. Other similar tests without the inclusion of RSV should be reported with a different code.

5. When to use CPT code 0241U

CPT code 0241U should be used when a clinician orders the Xpert® Xpress SARS–CoV–2/Flu/RSV test to determine the presence or absence of SARS–CoV–2, influenza A, influenza B, and RSV in an upper respiratory specimen. It is appropriate when there is suspicion of a viral respiratory tract infection and when the clinician requires rapid and accurate results for patient management and treatment decisions.

6. Documentation requirements

To support a claim for CPT code 0241U, the documentation should include:

• Indication for the test, such as suspected viral respiratory tract infection
• Type of upper respiratory specimen collected
• Date of service
• Results indicating the presence or absence of each pathogen
• Signature of the laboratory analyst performing the test

7. Billing guidelines

When billing for CPT code 0241U, ensure that the test performed is the Xpert® Xpress SARS–CoV–2/Flu/RSV from Cepheid. Report one unit of this code for each individual specimen analyzed on a single date of service. It is important to note that some payers may separately reimburse for the collection of the specimen, so it is advisable to check with the appropriate payer for their specific guidelines.

8. Historical information

CPT code 0241U was added to the Current Procedural Terminology system on October 6, 2020. There have been no updates or changes to the code since its addition.

9. Examples

1. A clinician orders the Xpert® Xpress SARS–CoV–2/Flu/RSV test for a patient presenting with respiratory symptoms to determine if they have COVID-19, influenza, or RSV.
2. A pediatrician suspects RSV infection in an infant and requests the Xpert® Xpress SARS–CoV–2/Flu/RSV test to confirm the presence or absence of the virus.
3. A primary care physician wants to differentiate between influenza and COVID-19 in a patient with flu-like symptoms and orders the Xpert® Xpress SARS–CoV–2/Flu/RSV test.
4. An emergency room physician needs to quickly identify the viral pathogen causing a patient’s respiratory illness and utilizes the Xpert® Xpress SARS–CoV–2/Flu/RSV test for rapid results.
5. A pulmonologist suspects a dual infection of influenza and RSV in a patient and orders the Xpert® Xpress SARS–CoV–2/Flu/RSV test to confirm the presence or absence of both viruses.
6. A family medicine physician wants to rule out COVID-19, influenza, and RSV in a patient with respiratory symptoms and requests the Xpert® Xpress SARS–CoV–2/Flu/RSV test.
7. An infectious disease specialist suspects a COVID-19 outbreak in a community and orders the Xpert® Xpress SARS–CoV–2/Flu/RSV test for multiple patients to quickly identify the presence or absence of the virus.
8. A geriatrician wants to determine the cause of a respiratory illness in an elderly patient and utilizes the Xpert® Xpress SARS–CoV–2/Flu/RSV test for accurate and timely results.
9. A pulmonologist suspects a potential co-infection of SARS–CoV–2 and influenza in a patient and orders the Xpert® Xpress SARS–CoV–2/Flu/RSV test to detect and differentiate between the two viruses.
10. A pediatrician wants to confirm the absence of SARS–CoV–2, influenza, and RSV in a child with respiratory symptoms and requests the Xpert® Xpress SARS–CoV–2/Flu/RSV test.