CPT Code Information

ICPT CODE: AMA CPT 0106U

TITLE: 13C-Spirulina Gastric Emptying Breath Test (GEBT)

TYPE OF CODE: CPT Proprietary Laboratory Analysis (PLA) Code

EFFECTIVE DATE: October 1, 2019

CODE DESCRIPTION: Gastric emptying evaluation; Serial collection of 7 timed breath specimens, utilizes Non-radioisotope carbon-13 (13C) Spirulina substrate, Analysis of each specimen by high precision gas isotope ratio mass spectrometry (GIRMS), Reported as rate of 13CO2 excretion (kPCD metric) at each measurement time.

CMS (Medicare) Coverage Information

INTENDED USE POPULATION: Patients age 18+ symptomatic for gastroparesis

COVERAGE DECISION DATES: July 29, 2020

CMS APPROVING BODY: Jurisdictions JJ, JM and MolDx, Palmetto GBA.

BASIS OF APPROVAL: FDA approval and “analytic and clinical validity as well as clinical utility in the evaluation of gastroparesis.”

REIMBURMENT:  $874.49 (national CMS fee schedule published January 1, 2021)

CPT Code Information

ICPT CODE: AMA CPT 0106U

TITLE: 13C-Spirulina Gastric Emptying Breath Test (GEBT)

TYPE OF CODE: CPT Proprietary Laboratory Analysis (PLA) Code

EFFECTIVE DATE: October 1, 2019

CODE DESCRIPTION: Gastric emptying evaluation; Serial collection of 7 timed breath specimens, utilizes Non-radioisotope carbon-13 (13C) Spirulina substrate, Analysis of each specimen by high precision gas isotope ratio mass spectrometry (GIRMS), Reported as rate of 13CO2 excretion (kPCD metric) at each measurement time.

CMS (Medicare) Coverage Information

Intended Use Population: Patients age 18+ symptomatic for gastroparesis

Coverage Decision Date: July 29, 2020

CMS Approving Body: Jurisdictions JJ, JM and MolDx, Palmetto GBA.

Basis of Approval:

FDA approval and “analytic and clinical validity as well as clinical utility in the evaluation of gastroparesis.”

Reimbursement: $874.49 (national CMS fee schedule published January 1, 2021)


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