Reimbursement · modulim.com

Reimbursement Information for CPT Code PLA 0061U

The following information regarding CPT Code 0061U is provided for convenience when billing for transcutaneous measurement of tissue oxygenation, oxyhemoglobin, deoxyhemoglobin, papillary and reticular dermal hemoglobin. It is not a substitute for a comprehensive review of coding, coverage, and payment policies. Please consult your local payer(s) regarding specific reimbursement guidance and billing criteria.

CPT Code:¹ 0061U

Effective Date:² January 1, 2020

Category: Proprietary Laboratory Analyses (PLA) code

Code Descriptor: Transcutaneous measurement of five biomarkers (tissue oxygenation [StO2] oxyhemoglobin [ctHbO2], deoxyhemoglobin [ctHbR], papillary and reticular dermal hemoglobin concentrations [ctHb1 and ctHb2]), using spatial frequency domain imaging (SFDI) and multi-spectral analysis.

Payment Amount:² $25.10 per test

CMS Evidence: Code can be found on 2020 Clinical Laboratory Fee Schedule (CLFS)

Diagnosis Codes: Providers are required to include diagnosis codes with each claim to describe the patient’s condition and why the service or procedure is reasonable and necessary.

CLIA Status

Clinical diagnostic laboratory test systems are categorized by their complexity from the least to the most complex: waived test, moderate complexity test, and high complexity tests. Waived tests are based on the premise that they are simple to use, and there is little chance the test will provide incorrect information or cause harm if it is done incorrectly. Noninvasive or transcutaneous tests are categorized as “CLIA Excluded” because it meets waived test criteria and doesn’t use “material derived from the human body”. 0061U is a transcutaneous measurement and does not require a CLIA number when submitting a claim.. CMS annually posts a list of CLIA Excluded tests on their website³.

The information in this guide should not be considered to be either legal or reimbursement advice. Modulim® makes no statement, promise or guarantee that the codes or other information in this guide are comprehensive, will remain timely, will be appropriate for the services provided, or will result in reimbursement. It is the provider’s responsibility to determine and submit appropriate codes, charges and modifiers for services that are rendered, in consultation with Medicare or other third-party payers, as applicable. Payers may have their own coverage, coding and billing requirements and providers should verify current requirements and policies before filing any claims.