RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Lab: Vectra™ DA

A53110

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A53110
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Lab: Vectra™ DA
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
04/28/2022
Revision Ending Date
06/07/2023
Retirement Date
06/07/2023
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

The MolDX Team has completed the Vectra DA assessment and determined that the test meets criteria for analytical and clinical validity, and clinical utility as a reasonable and necessary Medicare benefit. As per the conclusion of the clinical utility study, MolDX will reimburse Vectra DA tests performed for dates of service on and after 06/30/12. Based on the developer’s recommendation, this test should be limited to two services per patient per year.

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

Code Description
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Revenue Codes

Code Description
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CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

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Group 1 Codes
Code Description
81490 AUTOIMMUNE (RHEUMATOID ARTHRITIS), ANALYSIS OF 12 BIOMARKERS USING IMMUNOASSAYS, UTILIZING SERUM, PROGNOSTIC ALGORITHM REPORTED AS A DISEASE ACTIVITY SCORE
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(310 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
M05.00 Felty's syndrome, unspecified site
M05.011 Felty's syndrome, right shoulder
M05.012 Felty's syndrome, left shoulder
M05.019 Felty's syndrome, unspecified shoulder
M05.021 Felty's syndrome, right elbow
M05.022 Felty's syndrome, left elbow
M05.029 Felty's syndrome, unspecified elbow
M05.031 Felty's syndrome, right wrist
M05.032 Felty's syndrome, left wrist
M05.039 Felty's syndrome, unspecified wrist
M05.041 Felty's syndrome, right hand
M05.042 Felty's syndrome, left hand
M05.049 Felty's syndrome, unspecified hand
M05.051 Felty's syndrome, right hip
M05.052 Felty's syndrome, left hip
M05.059 Felty's syndrome, unspecified hip
M05.061 Felty's syndrome, right knee
M05.062 Felty's syndrome, left knee
M05.069 Felty's syndrome, unspecified knee
M05.071 Felty's syndrome, right ankle and foot
M05.072 Felty's syndrome, left ankle and foot
M05.079 Felty's syndrome, unspecified ankle and foot
M05.09 Felty's syndrome, multiple sites
M05.10 Rheumatoid lung disease with rheumatoid arthritis of unspecified site
M05.111 Rheumatoid lung disease with rheumatoid arthritis of right shoulder
M05.112 Rheumatoid lung disease with rheumatoid arthritis of left shoulder
M05.119 Rheumatoid lung disease with rheumatoid arthritis of unspecified shoulder
M05.121 Rheumatoid lung disease with rheumatoid arthritis of right elbow
M05.122 Rheumatoid lung disease with rheumatoid arthritis of left elbow
M05.129 Rheumatoid lung disease with rheumatoid arthritis of unspecified elbow
M05.131 Rheumatoid lung disease with rheumatoid arthritis of right wrist
M05.132 Rheumatoid lung disease with rheumatoid arthritis of left wrist
M05.139 Rheumatoid lung disease with rheumatoid arthritis of unspecified wrist
M05.141 Rheumatoid lung disease with rheumatoid arthritis of right hand
M05.142 Rheumatoid lung disease with rheumatoid arthritis of left hand
M05.149 Rheumatoid lung disease with rheumatoid arthritis of unspecified hand
M05.151 Rheumatoid lung disease with rheumatoid arthritis of right hip
M05.152 Rheumatoid lung disease with rheumatoid arthritis of left hip
M05.159 Rheumatoid lung disease with rheumatoid arthritis of unspecified hip
M05.161 Rheumatoid lung disease with rheumatoid arthritis of right knee
M05.162 Rheumatoid lung disease with rheumatoid arthritis of left knee
M05.169 Rheumatoid lung disease with rheumatoid arthritis of unspecified knee
M05.171 Rheumatoid lung disease with rheumatoid arthritis of right ankle and foot
M05.172 Rheumatoid lung disease with rheumatoid arthritis of left ankle and foot
M05.179 Rheumatoid lung disease with rheumatoid arthritis of unspecified ankle and foot
M05.19 Rheumatoid lung disease with rheumatoid arthritis of multiple sites
M05.20 Rheumatoid vasculitis with rheumatoid arthritis of unspecified site
M05.211 Rheumatoid vasculitis with rheumatoid arthritis of right shoulder
M05.212 Rheumatoid vasculitis with rheumatoid arthritis of left shoulder
M05.219 Rheumatoid vasculitis with rheumatoid arthritis of unspecified shoulder
M05.221 Rheumatoid vasculitis with rheumatoid arthritis of right elbow
M05.222 Rheumatoid vasculitis with rheumatoid arthritis of left elbow
M05.229 Rheumatoid vasculitis with rheumatoid arthritis of unspecified elbow
M05.231 Rheumatoid vasculitis with rheumatoid arthritis of right wrist
M05.232 Rheumatoid vasculitis with rheumatoid arthritis of left wrist
M05.239 Rheumatoid vasculitis with rheumatoid arthritis of unspecified wrist
M05.241 Rheumatoid vasculitis with rheumatoid arthritis of right hand
M05.242 Rheumatoid vasculitis with rheumatoid arthritis of left hand
M05.249 Rheumatoid vasculitis with rheumatoid arthritis of unspecified hand
M05.251 Rheumatoid vasculitis with rheumatoid arthritis of right hip
M05.252 Rheumatoid vasculitis with rheumatoid arthritis of left hip
M05.259 Rheumatoid vasculitis with rheumatoid arthritis of unspecified hip
M05.261 Rheumatoid vasculitis with rheumatoid arthritis of right knee
M05.262 Rheumatoid vasculitis with rheumatoid arthritis of left knee
M05.269 Rheumatoid vasculitis with rheumatoid arthritis of unspecified knee
M05.271 Rheumatoid vasculitis with rheumatoid arthritis of right ankle and foot
M05.272 Rheumatoid vasculitis with rheumatoid arthritis of left ankle and foot
M05.279 Rheumatoid vasculitis with rheumatoid arthritis of unspecified ankle and foot
M05.29 Rheumatoid vasculitis with rheumatoid arthritis of multiple sites
M05.30 Rheumatoid heart disease with rheumatoid arthritis of unspecified site
M05.311 Rheumatoid heart disease with rheumatoid arthritis of right shoulder
M05.312 Rheumatoid heart disease with rheumatoid arthritis of left shoulder
M05.319 Rheumatoid heart disease with rheumatoid arthritis of unspecified shoulder
M05.321 Rheumatoid heart disease with rheumatoid arthritis of right elbow
M05.322 Rheumatoid heart disease with rheumatoid arthritis of left elbow
M05.329 Rheumatoid heart disease with rheumatoid arthritis of unspecified elbow
M05.331 Rheumatoid heart disease with rheumatoid arthritis of right wrist
M05.332 Rheumatoid heart disease with rheumatoid arthritis of left wrist
M05.339 Rheumatoid heart disease with rheumatoid arthritis of unspecified wrist
M05.341 Rheumatoid heart disease with rheumatoid arthritis of right hand
M05.342 Rheumatoid heart disease with rheumatoid arthritis of left hand
M05.349 Rheumatoid heart disease with rheumatoid arthritis of unspecified hand
M05.351 Rheumatoid heart disease with rheumatoid arthritis of right hip
M05.352 Rheumatoid heart disease with rheumatoid arthritis of left hip
M05.359 Rheumatoid heart disease with rheumatoid arthritis of unspecified hip
M05.361 Rheumatoid heart disease with rheumatoid arthritis of right knee
M05.362 Rheumatoid heart disease with rheumatoid arthritis of left knee
M05.369 Rheumatoid heart disease with rheumatoid arthritis of unspecified knee
M05.371 Rheumatoid heart disease with rheumatoid arthritis of right ankle and foot
M05.372 Rheumatoid heart disease with rheumatoid arthritis of left ankle and foot
M05.379 Rheumatoid heart disease with rheumatoid arthritis of unspecified ankle and foot
M05.39 Rheumatoid heart disease with rheumatoid arthritis of multiple sites
M05.40 Rheumatoid myopathy with rheumatoid arthritis of unspecified site
M05.411 Rheumatoid myopathy with rheumatoid arthritis of right shoulder
M05.412 Rheumatoid myopathy with rheumatoid arthritis of left shoulder
M05.419 Rheumatoid myopathy with rheumatoid arthritis of unspecified shoulder
M05.421 Rheumatoid myopathy with rheumatoid arthritis of right elbow
M05.422 Rheumatoid myopathy with rheumatoid arthritis of left elbow
M05.429 Rheumatoid myopathy with rheumatoid arthritis of unspecified elbow
M05.431 Rheumatoid myopathy with rheumatoid arthritis of right wrist
M05.432 Rheumatoid myopathy with rheumatoid arthritis of left wrist
M05.439 Rheumatoid myopathy with rheumatoid arthritis of unspecified wrist
M05.441 Rheumatoid myopathy with rheumatoid arthritis of right hand
M05.442 Rheumatoid myopathy with rheumatoid arthritis of left hand
M05.449 Rheumatoid myopathy with rheumatoid arthritis of unspecified hand
M05.451 Rheumatoid myopathy with rheumatoid arthritis of right hip
M05.452 Rheumatoid myopathy with rheumatoid arthritis of left hip
M05.459 Rheumatoid myopathy with rheumatoid arthritis of unspecified hip
M05.461 Rheumatoid myopathy with rheumatoid arthritis of right knee
M05.462 Rheumatoid myopathy with rheumatoid arthritis of left knee
M05.469 Rheumatoid myopathy with rheumatoid arthritis of unspecified knee
M05.471 Rheumatoid myopathy with rheumatoid arthritis of right ankle and foot
M05.472 Rheumatoid myopathy with rheumatoid arthritis of left ankle and foot
M05.479 Rheumatoid myopathy with rheumatoid arthritis of unspecified ankle and foot
M05.49 Rheumatoid myopathy with rheumatoid arthritis of multiple sites
M05.50 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site
M05.511 Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder
M05.512 Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder
M05.519 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified shoulder
M05.521 Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow
M05.522 Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow
M05.529 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified elbow
M05.531 Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist
M05.532 Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist
M05.539 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified wrist
M05.541 Rheumatoid polyneuropathy with rheumatoid arthritis of right hand
M05.542 Rheumatoid polyneuropathy with rheumatoid arthritis of left hand
M05.549 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hand
M05.551 Rheumatoid polyneuropathy with rheumatoid arthritis of right hip
M05.552 Rheumatoid polyneuropathy with rheumatoid arthritis of left hip
M05.559 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hip
M05.561 Rheumatoid polyneuropathy with rheumatoid arthritis of right knee
M05.562 Rheumatoid polyneuropathy with rheumatoid arthritis of left knee
M05.569 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee
M05.571 Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot
M05.572 Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot
M05.579 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified ankle and foot
M05.59 Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites
M05.60 Rheumatoid arthritis of unspecified site with involvement of other organs and systems
M05.611 Rheumatoid arthritis of right shoulder with involvement of other organs and systems
M05.612 Rheumatoid arthritis of left shoulder with involvement of other organs and systems
M05.619 Rheumatoid arthritis of unspecified shoulder with involvement of other organs and systems
M05.621 Rheumatoid arthritis of right elbow with involvement of other organs and systems
M05.622 Rheumatoid arthritis of left elbow with involvement of other organs and systems
M05.629 Rheumatoid arthritis of unspecified elbow with involvement of other organs and systems
M05.631 Rheumatoid arthritis of right wrist with involvement of other organs and systems
M05.632 Rheumatoid arthritis of left wrist with involvement of other organs and systems
M05.639 Rheumatoid arthritis of unspecified wrist with involvement of other organs and systems
M05.641 Rheumatoid arthritis of right hand with involvement of other organs and systems
M05.642 Rheumatoid arthritis of left hand with involvement of other organs and systems
M05.649 Rheumatoid arthritis of unspecified hand with involvement of other organs and systems
M05.651 Rheumatoid arthritis of right hip with involvement of other organs and systems
M05.652 Rheumatoid arthritis of left hip with involvement of other organs and systems
M05.659 Rheumatoid arthritis of unspecified hip with involvement of other organs and systems
M05.661 Rheumatoid arthritis of right knee with involvement of other organs and systems
M05.662 Rheumatoid arthritis of left knee with involvement of other organs and systems
M05.669 Rheumatoid arthritis of unspecified knee with involvement of other organs and systems
M05.671 Rheumatoid arthritis of right ankle and foot with involvement of other organs and systems
M05.672 Rheumatoid arthritis of left ankle and foot with involvement of other organs and systems
M05.679 Rheumatoid arthritis of unspecified ankle and foot with involvement of other organs and systems
M05.69 Rheumatoid arthritis of multiple sites with involvement of other organs and systems
M05.70 Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement
M05.711 Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement
M05.712 Rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement
M05.719 Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement
M05.721 Rheumatoid arthritis with rheumatoid factor of right elbow without organ or systems involvement
M05.722 Rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement
M05.729 Rheumatoid arthritis with rheumatoid factor of unspecified elbow without organ or systems involvement
M05.731 Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement
M05.732 Rheumatoid arthritis with rheumatoid factor of left wrist without organ or systems involvement
M05.739 Rheumatoid arthritis with rheumatoid factor of unspecified wrist without organ or systems involvement
M05.741 Rheumatoid arthritis with rheumatoid factor of right hand without organ or systems involvement
M05.742 Rheumatoid arthritis with rheumatoid factor of left hand without organ or systems involvement
M05.749 Rheumatoid arthritis with rheumatoid factor of unspecified hand without organ or systems involvement
M05.751 Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement
M05.752 Rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement
M05.759 Rheumatoid arthritis with rheumatoid factor of unspecified hip without organ or systems involvement
M05.761 Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement
M05.762 Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement
M05.769 Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement
M05.771 Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement
M05.772 Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement
M05.779 Rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot without organ or systems involvement
M05.79 Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
M05.7A Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvement
M05.80 Other rheumatoid arthritis with rheumatoid factor of unspecified site
M05.811 Other rheumatoid arthritis with rheumatoid factor of right shoulder
M05.812 Other rheumatoid arthritis with rheumatoid factor of left shoulder
M05.819 Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder
M05.821 Other rheumatoid arthritis with rheumatoid factor of right elbow
M05.822 Other rheumatoid arthritis with rheumatoid factor of left elbow
M05.829 Other rheumatoid arthritis with rheumatoid factor of unspecified elbow
M05.831 Other rheumatoid arthritis with rheumatoid factor of right wrist
M05.832 Other rheumatoid arthritis with rheumatoid factor of left wrist
M05.839 Other rheumatoid arthritis with rheumatoid factor of unspecified wrist
M05.841 Other rheumatoid arthritis with rheumatoid factor of right hand
M05.842 Other rheumatoid arthritis with rheumatoid factor of left hand
M05.849 Other rheumatoid arthritis with rheumatoid factor of unspecified hand
M05.851 Other rheumatoid arthritis with rheumatoid factor of right hip
M05.852 Other rheumatoid arthritis with rheumatoid factor of left hip
M05.859 Other rheumatoid arthritis with rheumatoid factor of unspecified hip
M05.861 Other rheumatoid arthritis with rheumatoid factor of right knee
M05.862 Other rheumatoid arthritis with rheumatoid factor of left knee
M05.869 Other rheumatoid arthritis with rheumatoid factor of unspecified knee
M05.871 Other rheumatoid arthritis with rheumatoid factor of right ankle and foot
M05.872 Other rheumatoid arthritis with rheumatoid factor of left ankle and foot
M05.879 Other rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot
M05.89 Other rheumatoid arthritis with rheumatoid factor of multiple sites
M05.8A Other rheumatoid arthritis with rheumatoid factor of other specified site
M05.9 Rheumatoid arthritis with rheumatoid factor, unspecified
M06.00 Rheumatoid arthritis without rheumatoid factor, unspecified site
M06.011 Rheumatoid arthritis without rheumatoid factor, right shoulder
M06.012 Rheumatoid arthritis without rheumatoid factor, left shoulder
M06.019 Rheumatoid arthritis without rheumatoid factor, unspecified shoulder
M06.021 Rheumatoid arthritis without rheumatoid factor, right elbow
M06.022 Rheumatoid arthritis without rheumatoid factor, left elbow
M06.029 Rheumatoid arthritis without rheumatoid factor, unspecified elbow
M06.031 Rheumatoid arthritis without rheumatoid factor, right wrist
M06.032 Rheumatoid arthritis without rheumatoid factor, left wrist
M06.039 Rheumatoid arthritis without rheumatoid factor, unspecified wrist
M06.041 Rheumatoid arthritis without rheumatoid factor, right hand
M06.042 Rheumatoid arthritis without rheumatoid factor, left hand
M06.049 Rheumatoid arthritis without rheumatoid factor, unspecified hand
M06.051 Rheumatoid arthritis without rheumatoid factor, right hip
M06.052 Rheumatoid arthritis without rheumatoid factor, left hip
M06.059 Rheumatoid arthritis without rheumatoid factor, unspecified hip
M06.061 Rheumatoid arthritis without rheumatoid factor, right knee
M06.062 Rheumatoid arthritis without rheumatoid factor, left knee
M06.069 Rheumatoid arthritis without rheumatoid factor, unspecified knee
M06.071 Rheumatoid arthritis without rheumatoid factor, right ankle and foot
M06.072 Rheumatoid arthritis without rheumatoid factor, left ankle and foot
M06.079 Rheumatoid arthritis without rheumatoid factor, unspecified ankle and foot
M06.08 Rheumatoid arthritis without rheumatoid factor, vertebrae
M06.09 Rheumatoid arthritis without rheumatoid factor, multiple sites
M06.0A Rheumatoid arthritis without rheumatoid factor, other specified site
M06.1 Adult-onset Still's disease
M06.20 Rheumatoid bursitis, unspecified site
M06.211 Rheumatoid bursitis, right shoulder
M06.212 Rheumatoid bursitis, left shoulder
M06.219 Rheumatoid bursitis, unspecified shoulder
M06.221 Rheumatoid bursitis, right elbow
M06.222 Rheumatoid bursitis, left elbow
M06.229 Rheumatoid bursitis, unspecified elbow
M06.231 Rheumatoid bursitis, right wrist
M06.232 Rheumatoid bursitis, left wrist
M06.239 Rheumatoid bursitis, unspecified wrist
M06.241 Rheumatoid bursitis, right hand
M06.242 Rheumatoid bursitis, left hand
M06.249 Rheumatoid bursitis, unspecified hand
M06.251 Rheumatoid bursitis, right hip
M06.252 Rheumatoid bursitis, left hip
M06.259 Rheumatoid bursitis, unspecified hip
M06.261 Rheumatoid bursitis, right knee
M06.262 Rheumatoid bursitis, left knee
M06.269 Rheumatoid bursitis, unspecified knee
M06.271 Rheumatoid bursitis, right ankle and foot
M06.272 Rheumatoid bursitis, left ankle and foot
M06.279 Rheumatoid bursitis, unspecified ankle and foot
M06.28 Rheumatoid bursitis, vertebrae
M06.29 Rheumatoid bursitis, multiple sites
M06.30 Rheumatoid nodule, unspecified site
M06.311 Rheumatoid nodule, right shoulder
M06.312 Rheumatoid nodule, left shoulder
M06.319 Rheumatoid nodule, unspecified shoulder
M06.321 Rheumatoid nodule, right elbow
M06.322 Rheumatoid nodule, left elbow
M06.329 Rheumatoid nodule, unspecified elbow
M06.331 Rheumatoid nodule, right wrist
M06.332 Rheumatoid nodule, left wrist
M06.339 Rheumatoid nodule, unspecified wrist
M06.341 Rheumatoid nodule, right hand
M06.342 Rheumatoid nodule, left hand
M06.349 Rheumatoid nodule, unspecified hand
M06.351 Rheumatoid nodule, right hip
M06.352 Rheumatoid nodule, left hip
M06.359 Rheumatoid nodule, unspecified hip
M06.361 Rheumatoid nodule, right knee
M06.362 Rheumatoid nodule, left knee
M06.369 Rheumatoid nodule, unspecified knee
M06.371 Rheumatoid nodule, right ankle and foot
M06.372 Rheumatoid nodule, left ankle and foot
M06.379 Rheumatoid nodule, unspecified ankle and foot
M06.38 Rheumatoid nodule, vertebrae
M06.39 Rheumatoid nodule, multiple sites
M06.80 Other specified rheumatoid arthritis, unspecified site
M06.811 Other specified rheumatoid arthritis, right shoulder
M06.812 Other specified rheumatoid arthritis, left shoulder
M06.819 Other specified rheumatoid arthritis, unspecified shoulder
M06.821 Other specified rheumatoid arthritis, right elbow
M06.822 Other specified rheumatoid arthritis, left elbow
M06.829 Other specified rheumatoid arthritis, unspecified elbow
M06.831 Other specified rheumatoid arthritis, right wrist
M06.832 Other specified rheumatoid arthritis, left wrist
M06.839 Other specified rheumatoid arthritis, unspecified wrist
M06.841 Other specified rheumatoid arthritis, right hand
M06.842 Other specified rheumatoid arthritis, left hand
M06.849 Other specified rheumatoid arthritis, unspecified hand
M06.851 Other specified rheumatoid arthritis, right hip
M06.852 Other specified rheumatoid arthritis, left hip
M06.859 Other specified rheumatoid arthritis, unspecified hip
M06.861 Other specified rheumatoid arthritis, right knee
M06.862 Other specified rheumatoid arthritis, left knee
M06.869 Other specified rheumatoid arthritis, unspecified knee
M06.871 Other specified rheumatoid arthritis, right ankle and foot
M06.872 Other specified rheumatoid arthritis, left ankle and foot
M06.879 Other specified rheumatoid arthritis, unspecified ankle and foot
M06.88 Other specified rheumatoid arthritis, vertebrae
M06.89 Other specified rheumatoid arthritis, multiple sites
M06.8A Other specified rheumatoid arthritis, other specified site
M06.9 Rheumatoid arthritis, unspecified
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
06/07/2023 R18

This article is being retired because the information in this article is not up to date with 21st Century Cures requirements and is not supported by a Local Coverage Determination (LCD).

04/28/2022 R17

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added: M05.00, M05.019, M05.029, M05.039, M05.049, M05.059, M05.069, M05.079, M05.10, M05.119, M05.129, M05.139, M05.149, M05.159, M05.169, M05.179, M05.20,M05.219, M05.229, M05.239, M05.249, M05.259, M05.269, M05.279, M05.30, M05.319, M05.329, M05.339, M05.349, M05.359, M05.369, M05.379, M05.40, M05.419, M05.429, M05.439, M05.449, M05.459, M05.469, M05.479, M05.50, M05.519, M05.529, M05.539, M05.549, M05.559, M05.569, M05.579,M05.60, M05.619, M05.629, M05.639, M05.649, M05.659, M05.669, M05.679, M05.70, M05.719, M05.729, M05.739, M05.749, M05.759, M05.769, M05.779, M05.80, M05.819, M05.829, M05.839, M05.849, M05.859, M05.869, M05.879, M05.9, M06.00, M06.019, M06.029, M06.039, M06.049, M06.059, M06.069, M06.079, M06.20, M06.219, M06.229, M06.239, M06.249, M06.259, M06.269, M06.279, M06.30, M06.319, M06.329, M06.339, M06.349, M06.359, M06.369, M06.379, M06.80, M06.819, M06.829, M06.839, M06.849, M06.859, M06.869, M06.879, M06.9.

This revision is effective on 4/28/2022.

 

02/17/2022 R16

Under Article Title revised the title to read Billing and Coding: Lab: Vectra™ DA and removed verbiage regarding instructions on how to submit claims information.

This revision is effective on 02/17/2022.

10/24/2019 R15

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added M05.8A, M06.0A, M06.8A, and M05.7A. These revisions are due to the Annual ICD-10 Updates and become effective on 10/1/2020.

10/24/2019 R14

This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Under Article Title changed title from “MolDX: Vectra™ DA Coding and Billing Guidelines” to “Billing and Coding: MolDX: Vectra™ DA”. Under Article Text added verbiage, “For services on or after 01/01/2016” to second bullet. Formatting, punctuation and typographical errors were corrected throughout the article. CPT® was inserted throughout the article where applicable.

02/26/2018 R13 The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. The notice period for this article begins on 12/14/17 and ends on 02/25/18. Effective 02/26/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
01/29/2018 R12 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this article begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
11/23/2017 R11

Completed Annual Validation. No changes.

08/10/2017 R10

Added Part A contractor numbers to the policy.

12/15/2016 R9 Completed annual review. Replaced Z-Code™ Identifier with DEX Z-Code™ identifier. Added instruction for Part A clm submission.
11/13/2015 R8 Added 2016 CPT code to CPT/HCPCs Code Group 1
12/10/2015 R7 Reverted back to SV101-7 and removed MolDX ID field (MID), Corrected Z-Code ID to read Z-Code™ Identifier
and completed Annual review
11/13/2015 R6 Added 2016 CPT code
10/01/2015 R5 Replaced Palmetto references with MolDX
10/01/2015 R4 Changed CPT code to 81479 for claims received after 10/1/2014 and removed Z-Code ID.
10/01/2015 R3 Removed ICD-9s and ICD-10s from article text.
10/01/2015 R2 Revised ICD-10s to numerical order. Also added codes to ICD-10 coding section.
10/01/2015 R1 Reformatted ICD-10 codes to be consistent with Web article.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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LCDs
L35025 - MolDX: Molecular Diagnostic Tests (MDT)
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
06/07/2023 04/28/2022 - 06/07/2023 Retired You are here
04/18/2022 04/28/2022 - N/A Superseded View
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