SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: Repeat Germline Testing

A57332

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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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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57332
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: Repeat Germline Testing
Article Type
Billing and Coding
Original Effective Date
08/03/2020
Revision Effective Date
09/05/2024
Revision Ending Date
09/30/2024
Retirement Date
N/A

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.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e). Prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, §50.5 Jurisdiction of Laboratory Claims, §60.1.1 Independent Laboratory Specimen Drawing, §60.2 Travel Allowance

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

CMS Internet-Only Manual, 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: Repeat Germline Testing L38353

Response To Comments

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

(1 Code)
Group 1 Paragraph

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Group 1 Codes
Code Description
77 REPEAT PROCEDURE BY ANOTHER PHYSICIAN: THE PHYSICIAN MAY NEED TO INDICATE THAT A BASIC PROCEDURE OR SERVICE PERFORMED BY ANOTHER PHYSICIAN HAD TO BE REPEATED. THIS SITUATION MAY BE REPORTED BY ADDING MODIFIER -77 TO THE REPEATED PROCEDURE/SERVICE OR THE SEPARATE FIVE DIGIT MODIFIER CODE 09977 MAY BE USED.
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ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

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Group 1 Codes
Code Description
XX000 Not Applicable
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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.

Code Description

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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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Code Description

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Other Coding Information

Group 1

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Group 1 Codes
Code Description
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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
09/05/2024 R13

Under CPT/HCPCS Codes Group 1: Codes deleted 81288, 81345, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81416, 81417, 81420, 81422, 81426, and 81427. This revision is effective 9/5/2024.

 

07/01/2024 R12

Under CPT/HCPCS Codes Group 1: Codes added 0454U, 0460U, 0461U, 0474U, and 0475U. This revision is due to the 2024 Q3 CPT/HCPCS Code Update and is effective 7/1/2024.

04/01/2024 R11

Under CPT/HCPCS Codes Group 1: Codes added 0439U, 0440U, and 0449U. This revision is due to the 2024 Q2 CPT/HCPCS Code Update and is effective 4/1/2024.

01/01/2024 R10

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 81171, 81172, 81242, and 81243. Added 0425U and 0426U. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is effective 1/1/2024.

10/01/2023 R9

Updated to indicate this article is an LCD Reference Article.

10/01/2023 R8

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 0258U, 0269U, 0271U, 0272U, 0274U, 0277U, and 0278U. Added 0411U, 0417U, and 0419U. This revision is due to the 2023 Q4 CPT/HCPCS Code Update and is effective on 10/1/2023.

07/01/2023 R7

Under CMS National Coverage Policy updated section heading. This revision is effective on 7/1/2023.

Under CPT/HCPCS Codes Group 1: Codes added 0389U, 0392U, 0400U, and 0401U. This revision is due to the 2023 Q3 CPT/HCPCS Code Update and is effective on 7/1/2023.

 

04/01/2023 R6

Under CPT/HCPCS Codes Group 1: Codes added 0378U and 0380U. This revision is due to the 2023 Q2 CPT/HCPCS Code Update and is effective on 4/1/2023.

01/01/2023 R5

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 81330. Added 81418, 81441, and 0355U. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is effective on January 1, 2023.

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 0276U. This revision is due to the 2022 Q4 CPT/HCPCS Code Update and is effective for dates of service on or after 10/1/2022.

10/01/2022 R4

Under CPT/HCPCS Codes Group 1: Codes added 81307 and 81309. This revision is effective for dates of service on or after 10/1/2022.

Under CPT/HCPCS Codes Group 1: Codes deleted 0012U. Added 0345U, 0347U, 0348U, 0349U, and 0350U. This revision is due to the Q4 CPT/HCPCS Code Update and is effective for dates of service on or after 10/1/2022.

05/12/2022 R3

Under CPT/HCPCS Codes Group 1: Codes added 0318U. This revision is due to the Q2 CPT/HCPCS Code Update and is effective for dates of service on or after 4/1/2022.

Under CMS National Coverage Policy added regulation 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. Under CPT/HCPCS Codes Group 1: Codes deleted 81340, 81341, and 81342. Added 81220, 81221, 81222, 81223, 81224, 81419, 81493, 81554, 0001U, 0004M, 0012U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0078U, 0079U, 0084U, 0094U, 0101U, 0102U, 0103U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0169U, 0170U, 0173U, 0175U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0205U, 0209U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0221U, 0222U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0246U, 0258U, 0260U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, 0282U, 0286U, 0289U, 0290U , 0291U, 0292U, 0293U, and 0294U. This revision is effective 5/12/2022.

01/01/2022 R2

Under CPT/HCPCS Code Group 1: Codes the description was revised for 81228 and 81229. The revision is due to the 2022 Annual CPT/HCPCS Code Update and is effective on January 1, 2022. 

01/01/2021 R1

Under CPT/HCPCS Codes Group 1: Added 81168, 81191, 81192, 81193, 81194, 81278, 81279, 81338, 81339, 81347, 81348, 81351, 81352, 81353, 81357, 81360, 81419.

This revision is due to the Q1 2021 CPT/HCPCS Code Update and is effective for dates of service on or after 01/01/2021.

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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
L38353 - MolDX: Repeat Germline Testing
Related National Coverage Documents
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SAD Process URL 2
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Public Versions
Updated On Effective Dates Status
09/30/2024 10/01/2024 - N/A Currently in Effect View
08/29/2024 09/05/2024 - 09/30/2024 Superseded You are here
07/01/2024 07/01/2024 - 09/04/2024 Superseded View
04/01/2024 04/01/2024 - 06/30/2024 Superseded View
01/05/2024 01/01/2024 - 03/31/2024 Superseded View
11/22/2023 10/01/2023 - 12/31/2023 Superseded View
10/16/2023 10/01/2023 - N/A Superseded View
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