Apurva Posted Mon 01st of June, 2020 09:49:11 AM
Need clarification as to how many times CPT 81265 and 81266 can be billed to a patient in a life time
SuperCoder Answered Tue 02nd of June, 2020 03:24:29 AM
Thanks for your question.
Code 81265 should be reported with one unit of service (UOS). Except in rare cases, this service would only be performed once per lifetime.
Code 81266, when used in bone marrow transplants to report an additional double-cord blood sample, is a covered service.
Code 81267 should be used post transplantation to confirm successful engraftment or disease reoccurrance. Although the original donor specimen may be referenced, an additional 81265 should NOT be submitted in addition to the 81267 service. For labs that hold the pre-transplant specimen (81265 and/or 81266) until after the transplant occurs, use 81267 plus 81265 and 81266 if necessary.
EXCEPTIONS: Although the initial chimerism testing, code 81265, for engraftment is usually limited to once in a lifetime, MolDX recognizes special circumstances may require an additional service and will consider approval on a case-by-case basis through the appeal process.
Please feel free to write if you have any question.