RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: MECP2 Genetic

A53574

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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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Source Article ID
N/A
Article ID
A53574
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: MECP2 Genetic
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/24/2019
Revision Ending Date
04/26/2024
Retirement Date
04/26/2024

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Article Text

Effective for dates of service on and after February 19, 2013

Mutations found in methyl CpG binding protein 2(MECP2) are associated with Rett syndrome. In classic Rett syndrome, suspected cases are identified through specific clinical criteria in female children ages 1-5. Genetic testing is used to confirm the clinical findings. Since 99% of classic cases result in a single random mutation, genetic testing is not useful to screen carriers. Therefore, the MolDX Team has determined that MECP2 genetic testing is not a Medicare benefit and is a statutorily excluded service. In addition to single disease testing, MolDX will also deny panels of tests that include a MECP2 gene test as a statutorily excluded service.
To receive a MECP2 test denial, please submit the following claim information:

    • Appropriate CPT codes:
      • 81302- MECP2, full gene sequence
      • 81303- MECP2, known familial variant
      • 81304- MECP2, duplication/deletion variants
      • 81470 – X-linked intellectual disability genomic sequence analysis panel
      • 81471 – X-linked intellectual disability genomic sequence analysis panel duplication / deletion
      • 81479-MECP2, panel
    • An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
      • For a voluntary issued ABN, append with GX HCPCS modifier
      • To indicate a statutorily excluded service, append with a GY HCPCS modifier
    • Select the appropriate diagnosis for the patient
    • Enter DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types
      • Loop 2400 or SV101-7 for the 5010A1 837P
      • Box 19 for paper claim
    • Enter DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
      • Line SV202-7 for 837I electronic claim
      • Block 80 for the UB04 claim form

 

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Coding Information

Bill Type Codes

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CPT/HCPCS Modifiers

Group 1

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Group 1 Codes
Code Description
GX NOTICE OF LIABILITY ISSUED, VOLUNTARY UNDER PAYER POLICY
GY ITEM OR SERVICE STATUTORILY EXCLUDED, DOES NOT MEET THE DEFINITION OF ANY MEDICARE BENEFIT OR, FOR NON-MEDICARE INSURERS, IS NOT A CONTRACT BENEFIT
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ICD-10-CM Codes that Support Medical Necessity

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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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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.

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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.

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Other Coding Information

Group 1

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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
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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
04/27/2024 R9

This article is being retired because it is not supported by a Local Coverage Determination (LCD) and does not comply with current 21st Century Cures requirements.

10/24/2019 R8

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual. Under Article Title changed the title from “MolDX: MECP2 Genetic Testing Coding and Billing Guidelines” to “Billing and Coding: MolDX: MECP2 Genetic Testing”. Under Article Text removed the last paragraph. Under CPT/HCPCS Modifiers Group 1: Codes added modifiers GX and GY.

01/01/2019 R7

Added 81470 and 81471 to the article. Added all CPT codes: 81302, 81303, 81304, 81470, 81471, 81479 to CPT/HCPCS Codes Group 1. This change is due to the CPT/HCPCS 2019 Annual Update and is effective 1/1/19.

 

02/26/2018 R6 The Jurisdiction "J" Part A and Part B Contracts for Alabama (10111/10112), Georgia (10211/10212) and Tennessee (10311/10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these 6 contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 6 Part A and B contract numbers) have been completed in this revision.
07/06/2017 R5

Added Part A contractor numbers to article.

06/29/2017 R4

Updated Part A and Part B Billing Instructions

11/19/2015 R3 Changed "MolDX ID (MID) field" back to read SV101-7
11/19/2015 R2 Replace Palmetto reference with MolDX and replaced SV101-7 with MolDX ID (MID) field
10/01/2015 R1 Added CPT Code 81479 to "Appropriate CPT Code for test" bulletpoint.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Public Versions
Updated On Effective Dates Status
04/27/2024 10/24/2019 - 04/26/2024 Retired You are here
10/16/2019 10/24/2019 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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