LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: cobas® EGFR Mutation Test Guidelines

A54189

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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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General Information

Source Article ID
N/A
Article ID
A54189
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: cobas® EGFR Mutation Test Guidelines
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
11/16/2023
Revision Ending Date
N/A
Retirement Date
N/A

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Article Text

Effective for dates of service on and after 5/14/13, CGS Administrators and the MolDX program contractor will cover the FDA approved, cobas EGFR Mutation Test for the detection of epidermal growth factor receptor (EGFR) gene for non-small cell lung cancer (NSCLC) tumor tissue. The test is intended to be used to help select patients with NSCLC for whom Tarceva® (erlotinib), an EGFR tyrosine kinase inhibitor (TKI), is indicated.

To report a cobas service, please submit the following claim information:

    • CPT code 81479 – Unlisted chemistry procedure

 

    • Enter “ZBA66” in the comment/narrative field for the following claim field/types:

 

      • Loop 2300 NTE01 for part A or Loop 2400 NTE02/SV 101-7 for Part B
      • Submit “ZBA66” on an attachment to the claim form for paper claim(Form locator 80 fro Part A or Box 19 for Part B)

 

  • Select at least one ICD-10-CM diagnosis code from the following tables for dates of service on and after 10/01/2015
    • C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
    • C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
    • C34.2 Malignant neoplasm of middle lobe, bronchus or lung
    • C34.31-Malignant neoplasm of lower lobe, right bronchus or lung
    • C34.32-Malignant neoplasm of lower lobe, left bronchus or lung
    • C34.81-Malignant neoplasm of overlapping sites of right bronchus and lung
    • C34.82-Malignant neoplasm of overlapping sites of left bronchus and lung
    • C34.91-Malignant neoplasm of unspecified part of right bronchus or lung
    • C34.92-Malignant neoplasm of unspecified part of left bronchus or lung


NOTE: CGS and the MolDX Program contractor will apply NPI to ID editing. All labs that submit claims for the cobas EGFR kit MUST register the test and confirm the UNMODIFIED use of the kit. For lab developed tests (LDT) or tests that modify the cobas EGFR kit, CPT code 81235 should be reported and submitted with the assigned LDT test ID.

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Coding Information

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(9 Codes)
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Group 1 Codes
Code Description
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung
C34.91 Malignant neoplasm of unspecified part of right bronchus or lung
C34.92 Malignant neoplasm of unspecified part of left bronchus or lung
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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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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.

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Revenue Codes

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Other Coding Information

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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
11/16/2023 R9

Revision Effective: 11/16/2023

Revision Explanation: Updated LCD Reference Article section.

10/03/2019 R8

Revision Effective date: N/A
Revision Explanation: Annual review no changes made.

10/03/2019 R7

Revision Effective date: 10/03/2019
Revision Explanation: Converted article into new billing and coding article format.

10/01/2015 R6

Revision Effective date: N/A
Revision Explanation: Annual review no changes made.

10/01/2015 R5

Revision Effective date: N/A
Revision Explanation: Annual review no changes made

10/01/2015 R4 Revision Effective date: N/A
Revision Explanation: Annual review no changes made.
10/01/2015 R3 Revision Effective: N/A
Revision Explanation: Annual review no changes made.
10/01/2015 R2 R1
Revision Effective:10/01/2015
Revision Explanation: Changed MoPath to MolDX.
10/01/2015 R1 Revision Effective: N/A
Revision Explanation: Added Part A loop information.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L36021 - 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
11/08/2023 11/16/2023 - N/A Currently in Effect You are here
11/25/2019 10/03/2019 - 11/15/2023 Superseded View
09/26/2019 10/03/2019 - N/A Superseded View
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