RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: myPath® Melanoma Assay

A56878

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Draft Article
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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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56878
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: myPath® Melanoma Assay
Article Type
Billing and Coding
Original Effective Date
08/15/2019
Revision Effective Date
07/14/2022
Revision Ending Date
08/06/2023
Retirement Date
08/06/2023
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

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, §50.5 Jurisdiction of Laboratory Claims, §60.1.2 Independent Laboratory Specimen Drawing, §60.2 Travel Allowance

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §10 Reporting ICD Diagnosis and Procedure Codes

CMS Internet-Only Manuals, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 A/B MAC (B) Contacts With Independent Clinical Laboratories

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: myPath® Melanoma Assay L37907.

To report a myPath® Melanoma service, please submit the following claim information:

  • Select CPT® code 81479 for dates of service prior to 7/1/2019
  • For dates of service on or after 7/1/2019, select proprietary CPT® code 0090U
  • Enter 1 unit of service (UOS)
  • Enter the appropriate 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 the appropriate 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
  • Select the appropriate ICD-10-CM code

 

 

 

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

(2 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
81479 UNLISTED MOLECULAR PATHOLOGY PROCEDURE
0090U ONCOLOGY (CUTANEOUS MELANOMA), MRNA GENE EXPRESSION PROFILING BY RT-PCR OF 23 GENES (14 CONTENT AND 9 HOUSEKEEPING), UTILIZING FORMALIN-FIXED PARAFFIN-EMBEDDED (FFPE) TISSUE, ALGORITHM REPORTED AS A CATEGORICAL RESULT (IE, BENIGN, INTERMEDIATE, MALIGNANT)
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(22 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
D22.0 Melanocytic nevi of lip
D22.10 Melanocytic nevi of unspecified eyelid, including canthus
D22.111 Melanocytic nevi of right upper eyelid, including canthus
D22.112 Melanocytic nevi of right lower eyelid, including canthus
D22.121 Melanocytic nevi of left upper eyelid, including canthus
D22.122 Melanocytic nevi of left lower eyelid, including canthus
D22.20 Melanocytic nevi of unspecified ear and external auricular canal
D22.21 Melanocytic nevi of right ear and external auricular canal
D22.22 Melanocytic nevi of left ear and external auricular canal
D22.30 Melanocytic nevi of unspecified part of face
D22.39 Melanocytic nevi of other parts of face
D22.4 Melanocytic nevi of scalp and neck
D22.5 Melanocytic nevi of trunk
D22.60 Melanocytic nevi of unspecified upper limb, including shoulder
D22.61 Melanocytic nevi of right upper limb, including shoulder
D22.62 Melanocytic nevi of left upper limb, including shoulder
D22.70 Melanocytic nevi of unspecified lower limb, including hip
D22.71 Melanocytic nevi of right lower limb, including hip
D22.72 Melanocytic nevi of left lower limb, including hip
D22.9 Melanocytic nevi, unspecified
D48.5 Neoplasm of uncertain behavior of skin
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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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
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

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
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
08/06/2023 R7

Billing and coding article has been into been incorporated within the Billing and Coding: MoIDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma 

07/14/2022 R6

Revision Effective: 07/14/2022

Revision Explanation: Annual review, no changes made.

Y

01/01/2022 R5

Revision Effective: 01/01/2022

Revision Explanation: Under CPT/HCPCS Codes Group 1: Codes the description was revised for 0090U. This revision is due to the 2022 Annual CPT/HCPCS Code Update and is effective on January 1, 2022. Under Article Title added registered mark symbol to myPath, where applicable.

11/04/2021 R4

Revision Effective: 11/04/2021

Revision Explanation: Under Article Title added registered mark symbol to myPath. Under CMS National Coverage Policy added regulation CMS Internet-Only Manuals, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 A/B MAC (B) Contacts With Independent Clinical Laboratories and revised CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16 from §50.5 Jurisdiction of Laboratory Claims, §60.12 Independent Laboratory Specimen Drawing, §60.2 Travel Allowance to §50.5, §60.1.2, §60.2. myPath® was inserted throughout the article where applicable.

09/05/2019 R3

Revision Effective: n/a

Revision Explanation: Annual review, no changes made.

09/05/2019 R2

Revision Effective: 09/19/2019

Revision Explanation: Converted article into new Billing and Coding template no other changes made.

09/05/2019 R1

Under Article Text added all verbiage and corresponding bullet points under the first paragraph. In group 1 under CPT/HCPCS added code 0090U.This revision is due to the Q3 2019 CPT/HCPCS Code Update and is effective for dates of service on or after 7/1/2019.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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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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Other URLs
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Public Versions
Updated On Effective Dates Status
08/06/2023 07/14/2022 - 08/06/2023 Retired You are here
07/08/2022 07/14/2022 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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