RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing

A57768

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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
A57768
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
12/12/2021
Revision Ending Date
03/01/2023
Retirement Date
03/01/2023
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

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Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34518 Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. 

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. Providers are required to code to specificity, if CPT code 81479 (unlisted molecular pathology procedure) is used the documentation must clearly identify the unique molecular pathology procedure performed. When multiple procedure codes are submitted on a claim (unique and/or unlisted) the documentation supporting each code should be easily identifiable. If on review a billed code cannot be linked to the documentation, these services will be denied.
  5. The medical record must contain documentation that the testing is expected to influence treatment of the condition toward which the testing is directed. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition (ICD-10-CM code) that warrants the test(s).
  6. Documentation requirements of the performing laboratory (when requested) include, but are not limited to, lab accreditation, test requisition, test record/procedures, reports (preliminary and final), and quality control record.
  7. Documentation requirements for LDT(s)/protocols (when requested) include diagnostic test/assay, lab/manufacturer, names of comparable assays/services (if relevant), description of assay, analytical validity evidence, clinical validity evidence, and clinical utility. 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(10 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
Code Description
81370 Hla i & ii typing lr
81371 Hla i & ii type verify lr
81372 Hla i typing complete lr
81373 Hla i typing 1 locus lr
81375 Hla ii typing ag equiv lr
81376 Hla ii typing 1 locus lr
81378 Hla i & ii typing hr
81379 Hla i typing complete hr
81380 Hla i typing 1 locus hr
81382 Hla ii typing 1 loc hr
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(78 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide limited coverage for CPT codes: 81370, 81371, 81372, 81373, 81375, 81376, 81378, 81379, 81380, and 81382.

Group 1 Codes
Code Description
D69.49 Other primary thrombocytopenia
D69.59 Other secondary thrombocytopenia
T86.00 Unspecified complication of bone marrow transplant
T86.01 Bone marrow transplant rejection
T86.02 Bone marrow transplant failure
T86.03 Bone marrow transplant infection
T86.09 Other complications of bone marrow transplant
T86.10 Unspecified complication of kidney transplant
T86.11 Kidney transplant rejection
T86.12 Kidney transplant failure
T86.13 Kidney transplant infection
T86.19 Other complication of kidney transplant
T86.20 Unspecified complication of heart transplant
T86.21 Heart transplant rejection
T86.22 Heart transplant failure
T86.23 Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.298 Other complications of heart transplant
T86.30 Unspecified complication of heart-lung transplant
T86.31 Heart-lung transplant rejection
T86.32 Heart-lung transplant failure
T86.33 Heart-lung transplant infection
T86.39 Other complications of heart-lung transplant
T86.40 Unspecified complication of liver transplant
T86.41 Liver transplant rejection
T86.42 Liver transplant failure
T86.43 Liver transplant infection
T86.49 Other complications of liver transplant
T86.5 Complications of stem cell transplant
T86.810 Lung transplant rejection
T86.811 Lung transplant failure
T86.812 Lung transplant infection
T86.818 Other complications of lung transplant
T86.819 Unspecified complication of lung transplant
T86.830 Bone graft rejection
T86.831 Bone graft failure
T86.832 Bone graft infection
T86.838 Other complications of bone graft
T86.839 Unspecified complication of bone graft
T86.850 Intestine transplant rejection
T86.851 Intestine transplant failure
T86.852 Intestine transplant infection
T86.858 Other complications of intestine transplant
T86.859 Unspecified complication of intestine transplant
T86.890 Other transplanted tissue rejection
T86.891 Other transplanted tissue failure
T86.892 Other transplanted tissue infection
T86.898 Other complications of other transplanted tissue
T86.899 Unspecified complication of other transplanted tissue
T86.90 Unspecified complication of unspecified transplanted organ and tissue
T86.91 Unspecified transplanted organ and tissue rejection
T86.92 Unspecified transplanted organ and tissue failure
T86.93 Unspecified transplanted organ and tissue infection
T86.99 Other complications of unspecified transplanted organ and tissue
Z48.21* Encounter for aftercare following heart transplant
Z48.22* Encounter for aftercare following kidney transplant
Z48.23* Encounter for aftercare following liver transplant
Z48.24* Encounter for aftercare following lung transplant
Z48.280* Encounter for aftercare following heart-lung transplant
Z48.288* Encounter for aftercare following multiple organ transplant
Z48.290* Encounter for aftercare following bone marrow transplant
Z48.298* Encounter for aftercare following other organ transplant
Z94.0* Kidney transplant status
Z94.1* Heart transplant status
Z94.2* Lung transplant status
Z94.3* Heart and lungs transplant status
Z94.4* Liver transplant status
Z94.5* Skin transplant status
Z94.6* Bone transplant status
Z94.7* Corneal transplant status
Z94.81* Bone marrow transplant status
Z94.82* Intestine transplant status
Z94.83* Pancreas transplant status
Z94.84* Stem cells transplant status
Z94.89* Other transplanted organ and tissue status
Z94.9* Transplanted organ and tissue status, unspecified
Z95.3* Presence of xenogenic heart valve
Z95.4* Presence of other heart-valve replacement
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*The ICD-10-CM codes listed above with an asterisk should not be billed as a primary diagnosis.

Group 2

(1 Code)
Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM code supports medical necessity and provides limited coverage for CPT codes: 81376 and 81382.

Group 2 Codes
Code Description
K90.0 Celiac disease
N/A

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

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

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
999x Not Applicable
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
99999 Not Applicable
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
N/A
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
03/31/2023 R2

This article is being retired effective for dates of service on and after 03/01/2023 in response to the related LCD being retired.

12/12/2021 R1

Article revised and published on 12/09/2021 effective for dates of service 12/12/2021 in response to the new Pharmacogenomics Article, A58812 becoming effective 12/12/2021, CPT Codes 81374, 81377, 81381 and 81383 have been removed from the CPT/HCPCS Group 1 Codes section and from the ICD-10-CM Codes that Support Medical Necessity Group 1. ICD-10-CM Code Groups 2-4 have been removed. ICD-10-CM Code Group 5 has become ICD-10-CM Group 2. CPT codes 81377 and 81383 have been removed from the paragraph section.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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
03/31/2023 12/12/2021 - 03/01/2023 Retired You are here
12/03/2021 12/12/2021 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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