SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: BCR-ABL

A54686

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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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General Information

Source Article ID
N/A
Article ID
A54686
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: BCR-ABL
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

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.

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Article Guidance

Article Text

Effective for dates of service on and after 4/15/13

Breakpoint testing for BCR-ABL1 is commonly performed as a combination or panel of tests. To report multiple tests assigned a single ID, submit CPT® code 81479. This guideline includes the following CPT® code combinations:

  • 81206 and 81207
  • 81206, 81207, and 81208

CPT® codes 81206, 81207, and 81208 may only be reported when performed as a single test.

To submit a claim for BCR-ABL translocation analysis by NGS, use CPT® 81479 and one (1) UOS with the assigned DEX Z-code.

To report the FDA-approved MRDx BCR-ABL Test use the CPT® code 0040U.

Refer to Billing and Coding: MolDX: Testing of Multiple Genes A57910 for additional information regarding single-gene and panel testing of genes.

Response To Comments

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Coding Information

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ICD-10-CM Codes that Support Medical Necessity

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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.

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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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Other Coding Information

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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 R12

Revision Effective: 02/02/2023

Revision Explanation: Annual review, no changes.

02/10/2022 R11

Revision Effective: 02/10/2022

Revision Explanation: Under Article Text deleted the verbiage, “Laboratories performing BCR-ABL translocation analysis by NGS must obtain a DEX Z-code to differentiate NGS testing from non-NGS methods” and “Reimbursement is based on the number of reported gene(s) in small NGS panels. Tier 1 and/or Tier 2 individual biomarker CPT codes should not be used for a single gene or any combination of genes when testing is performed as part of a NGS or other multiplexing technology panel”. The verbiage, “Refer to Billing and Coding: MolDX: Testing of Multiple Genes A57503 for additional information regarding single-gene and panel testing of genes” was added at the end of the Article Text section.

 

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

01/02/2020 R10

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

01/02/2020 R9

Revision Effective: 01/02/2020
Revision Explanation:  Under Article Title changed title from “MolDX: BCR-ABL Coding and Billing Guidelines” to “Billing and Coding: MolDX: BCR-ABL”. CPT® was inserted throughout the article where applicable.

10/03/2019 R8

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

10/03/2019 R7

Revision Effective date: 10/03/2019
Revision Explanation: Converted into new billing and coding article format.

01/01/2019 R6

Revision Effective date: 01/01/2019
Revision Explanation: During annual HCPCS review new code 0040U was added to the article and updated information concerning NGS testing.

07/20/2017 R5

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

10/01/2015 R4

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

07/20/2017 R3

Revision Effective date: 07/20/2017
Revision Explanation: corrected formatting issues.

10/01/2015 R2 Revision Effective date: N/A
Revision Explanation: Annual review no changes made.
10/01/2015 R1 Revision Effective: N/A
Revision Explanation: Annual review no changes made.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Updated On Effective Dates Status
09/14/2024 09/19/2024 - N/A Currently in Effect View
11/08/2023 11/16/2023 - 09/18/2024 Superseded View
01/27/2023 02/02/2023 - 11/15/2023 Superseded You are here
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