Is it appropriate to use 0649T as an add-on code to multiparametric MRI of the prostate?

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“If the service is indeed justified and supported, we would recommend checking with the payer prior to submitting code 0649T,” write Jonathan Rubenstein, MD, and Mark Painter.

Is it appropriate to use 0649T(quantitative magnetic resonance for analysis of tissue composition [eg, fat, iron, water content], including multiparametric data acquisition, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the same anatomy [eg, organ, gland, tissue, target structure]; single organ [list separately in addition to code for primary procedure])as an add-on code to multiparametric MRI of the prostate?

Code 0649T was accepted as an “investigational” (category III) code at a Current Procedural Terminology (CPT) meeting last year, using this seemingly proprietary liver imaging test as the justification. The Federal Register mentions its use specifically with this particular liver scan.1

However, the CPT code, as is typical for CPT codes, was written to address the technology more broadly instead of referencing a particular test or service. As published, it does appear to leave the door open to be used in other organs such as the prostate (72197), and there is no list of primary codes that would restrict its use as an add-on for code 72197.

However, neither the American Urological Association nor Physician Reimbursement Systems have been made aware that it could or would be used for the prostate. Radiologists have been reading prostate MRIs using 72197 for around a decade without discussion that another add-on code would be needed or appropriate. We are unaware of the efficacy related to the service or whether the analysis is additional or included relative to code 72197.

Codes 0648T and 0649T were designed to report QuantitativeMultiparametric MR for analysis of tissue composition. They were designed to be used in any organ or tissue in the body. However, the key word is quantitative, meaning an actual quantitative analysis must be performed. That requires actual reporting of quantitative values related to tissue properties, not just a qualitative assessment. There are many examples of quantitative sequences being qualitatively interpreted and that would not meet the threshold of coding 0648T or 0649T. Currently, the most common use for these new codes is in the liver, but research is ongoing for their use in other organs. In our experience thus far, this type of quantitative assessment and reporting is not typically being performed in conjunction with prostate MRI.

Coverage as noted in the Federal Register at this time appears to be restricted to the liver scan. If the service is indeed justified and supported, we would recommend checking with the payer prior to submitting code 0649T.

Reference

1. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Price Transparency of Hospital Standard Charges; Radiation Oncology Model. Federal Register. 2021;86(218):84. Accessed March 18, 2022. https://www.federalregister.gov/documents/2021/11/16/2021-24011/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment

Send coding and reimbursement questions to Jonathan Rubenstein, MD, and Mark Painter c/o Urology Times®, at UTeditors@mjhlifesciences.com.

Questions of general interest will be chosen for publication. The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.