SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing

A54685

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Superseded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

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A54685
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
02/02/2023
Revision Ending Date
11/15/2023
Retirement Date
N/A

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Article Guidance

Article Text

Effective for dates of service on and after February 7, 2013

ARVD/C, characterized by fatty replacement of heart cells predominantly in the right ventricle of the heart, is most often inherited as an autosomal dominant disease that may be associated with testing in at least seven genes (RYR2, TMEM43, DSP, PKP2, DSG2, DSC2 and JUP). Genetic testing may be performed in panels of 5-7 of these genes and disease-causing mutation is expected to be identified in 42-55% of cases. Testing would be performed to confirm an established diagnosis or on individuals already diagnosed with ARVD/C to identify family members at risk. Therefore, MolDX has determined that testing for ARVD/C is a statutorily excluded test.

To receive an ARVD/C panel test denial, please submit the following claim information:

  • CPT®code 81439
  • An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
    • For a voluntary issued ABN, append with GX modifier
    • To indicate a statutorily excluded service, append with a GY modifier
  • Select the appropriate diagnosis for the patient
  • Enter the appropriate DEX Z-codeTM identifier adjacent to the CPT code in the comment/narrative field for the following claim field/types:
    • Line SV202-7 for 837I Part A or Loop 2400 or SV101-7 for the 5010A1 837P for Part B
    • Block 80 for Part A or Box 19 for Part B paper claim



Response To Comments

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Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

(2 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
GX NOTICE OF LIABILITY ISSUED, VOLUNTARY UNDER PAYER POLICY
GY ITEM OR SERVICE STATUTORILY EXCLUDED, DOES NOT MEET THE DEFINITION OF ANY MEDICARE BENEFIT OR, FOR NON-MEDICARE INSURERS, IS NOT A CONTRACT BENEFIT
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ICD-10-CM Codes that Support Medical Necessity

Group 1

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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.

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
02/02/2023 R13

Revision Effective: 02/02/2023
Revision Explanation: Annual review no changes made.

07/15/2021 R12

Revision Effective: 7/15/2021
Revision Explanation:Under Article Title removed Coding and Billing Guidelines from the end of the title. Under Article Text removed the reference to the regulation Title XVIII of the Social Security Act, §1862 (a)(1)(A). Under CPT/HCPCS Modifiers Group 1: Codes added GX and GY. CPT® was inserted throughout the article where applicable.

09/19/2019 R11

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

09/19/2019 R10

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

09/19/2019 R9

Revision Effective: 09/19/2019

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

01/01/2019 R8

Revision Effective date: 01/01/2019
Revision Explanation: During annual HCPCS review new code 81439 replaced 81479.

10/01/2017 R7

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

10/01/2015 R6

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

10/01/2017 R5

Revision Effective date: 10/01/2017
Revision Explanation: Replaced "identifier" verbiage with the appropriate DEX Z code identifier verbiage.

10/01/2015 R4 Revision Effective date: N/A
Revision Explanation: Annual review no changes made.
10/01/2015 R3 Revision Effective: 10/01/2015
Revision Explanation: Corrected palmetto GBA to MolDX and added panel after ARVD/C in sentence above information submitted on claim.
10/01/2015 R2 Revision Effective: N/A
Revision Explanation: Annual review no changes made.
10/01/2015 R1 R1
Revision Effective: 10/01/2015
Revision Explanation: Left CPT code out of list of CPT codes.
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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 2
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Public Versions
Updated On Effective Dates Status
11/08/2023 11/16/2023 - N/A Currently in Effect View
01/27/2023 02/02/2023 - 11/15/2023 Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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