CPT 0224U Mount Sinai IgG Test Reimbursement | OpenPayer

Summary & Overview

CPT 0224U: Mount Sinai COVID-19 IgG Antibody Test

CPT code 0224U identifies a Proprietary Laboratory Analyses (PLA) assay for the Mount Sinai COVID‑19 Antibody Test, a serologic test targeting human IgG to SARS–CoV–2. As a PLA code, 0224U applies to a single manufacturer-specific test and is used in claims to distinguish this unique laboratory service. Nationally, PLA codes like 0224U matter because they enable tracking and reimbursement of proprietary assays developed during public health responses and for specialized diagnostics.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for SARS–CoV–2 IgG antibody testing, typical sites of service and laboratory workflows, and the billing implications of a PLA-level CPT code. The publication summarizes payer coverage patterns and benchmarks where available, explains coding and claim reporting conventions for proprietary tests, and highlights policy considerations tied to PLA coding and laboratory-developed testing. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0224UCPTPLACOVID-19antibody testingserologyclinical laboratorySARS-CoV-2IgG

Billing Code Overview

CPT code 0224U is a Proprietary Laboratory Analyses (PLA) code for the Mount Sinai COVID-19 Antibody Test, a laboratory assay that detects human IgG antibodies to SARS–CoV–2 in serum and plasma specimens. The test may include antibody titers to measure the concentration of IgG antibodies in blood.

Service type: Laboratory — serology/antibody testing

Typical site of service: Clinical laboratory or hospital laboratory (specimen collection may occur in outpatient clinics or phlebotomy sites)

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or pediatric outpatient who presents to a primary care clinic, occupational health clinic, blood draw station, or hospital outpatient phlebotomy service seeking evaluation of prior exposure to SARS–CoV–2. The clinician documents symptoms consistent with past COVID-19 illness or documents a history of a positive viral test and requests serologic confirmation of IgG antibody response. A venous blood specimen (serum or plasma) is collected by trained phlebotomy staff and sent to the laboratory performing the proprietary Mount Sinai COVID–19 Antibody Test. The laboratory analyst performs the assay, which may include reporting qualitative IgG detection and, when ordered, antibody titers reflecting concentration. Results are returned to the ordering provider and incorporated into the patient’s electronic health record; results may inform occupational clearance, seroprevalence assessment, post-infection immune response evaluation, or eligibility for certain studies. Typical sites of service include outpatient clinics, hospital outpatient labs, commercial reference laboratories, and dedicated phlebotomy centers. The service type is clinical laboratory testing (Proprietary Laboratory Analyses, PLA) performed by a certified clinical laboratory using a manufacturer-specific assay.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier	Used when no other modifier applies to the claim.

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Taxonomy Code	Specialty	Notes
207Q00000X	Infectious Disease	Physicians who evaluate patients for prior SARS–CoV–2 infection and order serology.
208D00000X	Pathology	Pathologists responsible for laboratory oversight, test validation, and result interpretation.
363L00000X	Clinical Laboratory	Clinical laboratory technicians and directors who perform and report the PLA assay.
207L00000X	Internal Medicine	Primary care and internal medicine clinicians who order serology for patient management.
207P00000X	Emergency Medicine	Emergency clinicians who may order serology in select post-acute evaluations.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z86.16`	Personal history of COVID-19	Indicates prior SARS–CoV–2 infection; serology may document post-infectious antibody presence.
`Z20.828`	Contact with and (suspected) exposure to other viral communicable diseases	Used when assessing possible prior exposure and ordering serologic testing.
`R68.89`	Other general symptoms and signs	Nonspecific post-infectious symptoms prompting evaluation with antibody testing.
`R53.83`	Other fatigue	Post-viral fatigue evaluation where serology may support prior infection as a potential cause.
`Z00.6`	Encounter for examination for normal comparison and control in clinical research program	Used when serology is performed as part of research or surveillance efforts assessing seroprevalence.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81002`	Urinalysis, by dipstick or tablet reagent; automated, without microscopy	Common point-of-care test performed at the same visit for general screening; unrelated to antibody measurement but often billed from outpatient encounters.
`36415`	Collection of venous blood by venipuncture	Performed immediately prior to sending serum or plasma to the laboratory for the `0224U` assay; documents specimen collection.
`99000`	Handling and/or conveyance of specimen for transfer from physician office to a laboratory	Used when clinical offices bill for specimen handling/shipping to the reference lab performing the proprietary assay.
`99070`	Supplies and materials (e.g., local and systemic medications), used in the office (list drugs, trays, supplies)	May be billed by the ordering facility for specific supplies related to phlebotomy when separately billable.
`87635`	Infectious agent antigen detection by immunoassay, (e.g., SARS-CoV-2)	Often performed earlier in the clinical course for acute infection; serology `0224U` is complementary for prior exposure assessment.

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