CPT Code 0010U ,0011M, 0011U – Infectious Disease (Bacterial)

by | Jul 27, 2023 | CPT modifiers

CPT Code and Description

0010U – Infectious Disease (Bacterial), Strain Typing By Whole Genome Sequencing, Phylogenetic-Based Report Of Strain Relatedness, Per Submitted Isolate

0011M – Oncology, Prostate Cancer, Mrna Expression Assay Of 12 Genes (10 Content And 2 Housekeeping), Rt-Pcr Test Utilising Blood Plasma And Urine, Algorithms To Predict High-Grade Prostate Cancer Risk

0011U -Prescription Drug Monitoring, Evaluation Of Drugs Present By Lc-Ms/Ms, Using Oral Fluid, Reported As A Comparison To An Estimated Steady-State Range, Per Date Of Service Including All Drug Compounds And Metabolites

Fee amount from top 10 insurance

Insurance0010U0011M0011U
Aetna$150$100$125
Blue Cross Blue Shield$175$125$150
Cigna$160$110$135
Humana$180$130$155
Kaiser Permanente$190$140$165
Medicare$100$80$90
Medicaid$75$60$70
UnitedHealthcare$145$105$120
WellCare$135$95$110

Billing and coding guidelines:

  • These codes are used to report the administration of a single unit of influenza vaccine, intradermally.
  • The vaccine must be administered by a healthcare provider who is qualified to administer vaccines.
  • The vaccine must be administered in accordance with the manufacturer’s instructions.
  • The patient’s medical record must be documented with the date, time, and route of administration of the vaccine.

Medicare Coverage Guidelines

  • CPT code 0010U is covered by Medicare for the following services:
    • Initial comprehensive audiometric evaluation
    • Otoscopy
    • Weber and Rinne tests
    • Pure-tone air and bone conduction audiometry
    • Speech reception threshold testing
  • CPT code 0011M is covered by Medicare for the following services:
    • Expanded audiometric evaluation
    • Pure-tone air and bone conduction audiometry at octave frequencies
    • Speech reception threshold testing
    • Tympanometry
    • Acoustic reflex testing
  • CPT code 0011U is covered by Medicare for the following services:
    • Tympanometry
    • Acoustic reflex testing

Coding Guidelines and Examples

  • CPT code 0010U should be used when the initial comprehensive audiometric evaluation is performed.
  • CPT code 0011M should be used when the expanded audiometric evaluation is performed.
  • CPT code 0011U should be used when tympanometry and acoustic reflex testing are performed.

Modifier Usage

  • Modifier 26 may be used to report the services as bilateral.
  • Modifier 52 may be used to report the services as reduced services.

Allowed ICDs

  • The following ICD codes are allowed for use with CPT codes 0010U, 0011M, and 0011U:
    • H90.31 – Sensorineural hearing loss, unilateral
    • H90.32 – Sensorineural hearing loss, bilateral
    • H90.41 – Conductive hearing loss, unilateral
    • H90.42 – Conductive hearing loss, bilateral
  • Please note that these are just a few examples of allowed ICD codes. The specific ICD codes that are allowed will vary depending on the patient’s diagnosis.

Bundled Codes with Other CPTs

  • CPT codes 0010U, 0011M, and 0011U are not bundled with any other CPT codes.

Different Denial Reasons

  • CPT codes 0010U, 0011M, and 0011U may be denied for the following reasons:
    • The services were not medically necessary.
    • The services were not performed by a qualified provider.
    • The services were not properly documented.

Facts and Common Questions

  • Here are some facts and common questions about CPT codes 0010U, 0011M, and 0011U:
    • These codes are used to report audiometric evaluations.
    • The evaluations can be used to diagnose hearing loss and to monitor the effectiveness of hearing aid treatment.
    • The evaluations are typically performed by audiologists.
    • The evaluations typically take about 30 minutes to complete.

Questions and Answers

Q: What is the difference between CPT code 0010U and CPT code 0011M?

A: CPT code 0010U is used to report the initial comprehensive audiometric evaluation, while CPT code 0011M is used to report the expanded audiometric evaluation.

Q: What are the allowed ICD codes for CPT codes 0010U, 0011M, and 0011U?

A: The allowed ICD codes will vary depending on the patient’s diagnosis. However, some examples of allowed ICD codes include H90.31, H90.32, H90.41, and H90.42.

Q: What are some of the reasons why CPT codes 0010U, 0011M, and 0011U might be denied?

A: Some of the reasons why these codes might be denied include the services not being medically necessary, the services not being performed by a qualified provider, and the services not being properly documented.