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High Sensitivity C-Reactive Protein Testing: Not Covered
High sensitivity C-reactive protein testing (high-sensitivity CRP, CPT code 86141) is not covered by Palmetto GBA.
- Among claims submitted to Palmetto GBA, one of the services with a high volume of denials is CPT code 86141. These services are denied with reason code 50 / remark code 115.
- Palmetto GBA has published a non-coverage policy for high sensitivity C-reactive protein. To locate the full text of this policy, refer to:
- Current literature does not support the use of high sensitivity CRP for diagnostic purposes
- Medicare does not cover high sensitivity CRP testing for screening, prevention or risk stratification of cardiovascular disease
- Standard sensitivity CRP (CPT code 86140) is covered as a diagnostic test for the detection and evaluation of infection, tissue injury and inflammatory disease. The results of these diagnostic tests must show an impact to the patient's care plan.
Claim Submission for High Sensitivity CRP
- Because CPT code 86141 is always non-covered by Palmetto GBA on the basis of 'not reasonable and medically necessary,' we encourage you to provide your patients with an Advance Beneficiary Notice (ABN) prior to performing these tests
- ABNs allow patients to make an informed decision about whether to receive a service that is likely to be non-covered on the basis of 'not reasonable and medically necessary.'
- If you utilize ABNs, they must be issued in advance. Maintain a copy in the patient's medical record. We also recommend that you provide the patient with a copy of the signed notice.
- ABNs must be issued using the standard CMS form. CMS provides an ABN specifically for clinical laboratory services. Access the ABN-L and other background information from the CMS Web site
- If you have obtained a valid ABN, submit claims for this service with HCPCS modifier GA