CPT® Code 81490

Official Description

Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score

Common Language Description

The CPT® Code 81490 refers to a specialized blood test designed to analyze autoimmune biomarkers specifically in patients diagnosed with rheumatoid arthritis (RA). This autoimmune disease is characterized by chronic inflammation of the joints, leading to pain, progressive destruction of joint tissue, and ultimately a loss of function. The test measures a total of 12 distinct biomarkers that are crucial for understanding the heterogeneity of an individual's disease. By identifying these biomarkers, healthcare providers can assess the severity of the condition and make informed decisions regarding therapeutic interventions. The biomarkers included in this analysis are Interleukin-6 (IL-6), Tumor necrosis factor receptor type 1 (TNFR1), Vascular cell adhesion molecule 1 (VCAM-1), Epidermal growth factor (EGF), Vascular endothelial growth factor A (VEGF-A), YKL-40, Matrix metalloproteinase 1 (MMP-1), Matrix metalloproteinase 3 (MMP-3), C-reactive protein (CRP), Serum amyloid A (SAA), Leptin, and Resistin. The test utilizes serum obtained from a blood sample, which is collected through a procedure known as venipuncture. The serum is then analyzed using multiplexed sandwiched immunoassays that employ biomarker-specific capture antibodies. The results of this analysis are reported as a multi-biomarker disease activity (MBDA) score, which ranges from 0 to 100, providing a prognostic algorithm that aids in the management of rheumatoid arthritis.

1. Indications

The CPT® Code 81490 is indicated for use in patients diagnosed with rheumatoid arthritis (RA). The test is performed to evaluate the disease activity and assist in the management of the condition. The following are specific indications for this procedure:

Rheumatoid Arthritis Diagnosis - The test is utilized in patients who have been diagnosed with rheumatoid arthritis to assess the severity and activity of the disease.
Monitoring Disease Activity - It helps in monitoring the disease activity over time, allowing for adjustments in treatment plans based on the patient's current status.
Therapeutic Intervention Selection - The results can guide healthcare providers in selecting appropriate therapeutic interventions tailored to the individual patient's disease profile.

2. Procedure

The procedure for CPT® Code 81490 involves several key steps that ensure accurate analysis of the biomarkers associated with rheumatoid arthritis. The following outlines the procedural steps:

Step 1: Patient Preparation - Prior to the blood draw, the patient may be instructed to follow specific guidelines to ensure optimal test results, although no fasting is typically required.
Step 2: Venipuncture - A qualified healthcare professional performs venipuncture to obtain a blood sample from the patient. This involves inserting a needle into a vein, usually in the arm, to collect the necessary serum for testing.
Step 3: Serum Separation - Once the blood sample is collected, it is processed to separate the serum from the cellular components. This is typically done by centrifugation, which spins the sample at high speeds to facilitate separation.
Step 4: Immunoassay Testing - The serum is then subjected to multiplexed sandwiched immunoassays. This technique utilizes biomarker-specific capture antibodies to detect and quantify the 12 biomarkers associated with rheumatoid arthritis.
Step 5: Result Interpretation - After the immunoassay testing is complete, the results are compiled and analyzed to generate a multi-biomarker disease activity (MBDA) score. This score ranges from 0 to 100 and serves as a prognostic algorithm to assess disease activity.

3. Post-Procedure

After the procedure, the patient may experience minimal discomfort at the venipuncture site, which typically resolves quickly. There are no specific post-procedure care instructions required for this test. However, patients are advised to monitor the site for any unusual symptoms, such as excessive bleeding or signs of infection. The results of the test will be communicated to the healthcare provider, who will interpret the MBDA score and discuss the implications for the patient's treatment plan and ongoing management of rheumatoid arthritis.

Short Descr	AUTOIMMUNE RA ALYS 12 BMRK
Medium Descr	AUTOIMMUNE RHEUMATOID ARTHRITIS ALYS 12 BMRK
Long Descr	Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
CLIA Waived (QW)	No
APC Status Indicator	Service Paid under Fee Schedule or Payment System other than OPPS
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T1H - Lab tests - other (non-Medicare fee schedule)
MUE	1

90	Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.
GA	Waiver of liability statement issued as required by payer policy, individual case
GW	Service not related to the hospice patient's terminal condition