SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer

A58211

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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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To see the currently-in-effect version of this document, go to the section.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A58211
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
Article Type
Billing and Coding
Original Effective Date
07/18/2021
Revision Effective Date
08/13/2023
Revision Ending Date
12/31/2023
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 lacking the necessary documentation to process the claim.

CMS Internet-Only Manual, Publication 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: Prognostic and Predictive Molecular Classifiers for Bladder Cancer L38684.

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

  • Select the appropriate CPT® code
  • 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

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(9 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
C67.0 - C67.8 Malignant neoplasm of trigone of bladder - Malignant neoplasm of overlapping sites of bladder
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 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.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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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
08/13/2023 R7

Posted 06/29/2023: Review completed with no change in coverage. No changes were made to the article.

01/01/2023 R6

Posted 01/26/2023: Under CPT/HCPCS Codes Group 1 Codes, 81445 had a description change. This revision is due to the Annual 2023/Q1 CPT/HCPCS Code Update and is effective 01/01/2023.

07/01/2022 R5

Posted 09/012022- Under CPT/HCPCS Codes Group 1: Codes the description was revised for 0016M. This revision is due to the Q3 2022 CPT/HCPCS Code Update and is effective 07/01/2022. Review completed 07/19/2022.

01/27/2022 R4

01/27/2022-Under Article Text CPT 81479 was removed from the sentence “Select the appropriate CPT® code.”

01/01/2022 R3

12/30/2021-CPT/HCPCs code update: desc change 0016M.

09/30/2021 R2

09/30/2021-Under Article Text deleted #1 verbiage regarding coverage for Decipher Bladder criteria and #2 verbiage related to coverage for tests FGFR2 and FGFR3.

07/18/2021 R1

07/01/2021 Under Article Text revised the fourth bullet to remove cystectomy. Formatting, punctuation and typographical errors were corrected throughout the article.

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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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Public Versions
Updated On Effective Dates Status
01/23/2024 01/01/2024 - N/A Currently in Effect View
06/22/2023 08/13/2023 - 12/31/2023 Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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