Local Coverage Article Billing and Coding

Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment

A57055

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General Information

Article ID
A57055
Article Title
Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
Article Type
Billing and Coding
Original Effective Date
10/01/2019
Revision Effective Date
10/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
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CPT codes, descriptions and other data only are copyright 2022 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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Copyright © 2022, 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

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 Manuals, Publication 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

CMS Internet Online Manual Pub. 100-04, (Medicare Claims Processing Manual), Chapter 23 §10 Reporting ICD Diagnosis and Procedure Codes

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Biomarkers in Cardiovascular Risk Assessment L36362.

Coding Information

CPT/HCPCS Codes

Group 1

(11 Codes)
Group 1 Paragraph

The following CPT codes are covered:

Group 1 Codes
CodeDescription
82172 APOLIPOPROTEIN, EACH
82610 CYSTATIN C
83090 HOMOCYSTEINE
83695 LIPOPROTEIN (A)
83698 LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (LP-PLA2)
83700 LIPOPROTEIN, BLOOD; ELECTROPHORETIC SEPARATION AND QUANTITATION
83701 LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRACTIONATION AND QUANTITATION OF LIPOPROTEINS INCLUDING LIPOPROTEIN SUBCLASSES WHEN PERFORMED (EG, ELECTROPHORESIS, ULTRACENTRIFUGATION)
83704 LIPOPROTEIN, BLOOD; QUANTITATION OF LIPOPROTEIN PARTICLE NUMBER(S) (EG, BY NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY), INCLUDES LIPOPROTEIN PARTICLE SUBCLASS(ES), WHEN PERFORMED
83719 LIPOPROTEIN, DIRECT MEASUREMENT; VLDL CHOLESTEROL
83721 LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL
86141 C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(177 Codes)
Group 1 Paragraph

The following ICD-10 codes are covered:

Group 1 Codes
CodeDescription
E71.30 Disorder of fatty-acid metabolism, unspecified
E75.21 Fabry (-Anderson) disease
E75.22 Gaucher disease
E75.240 Niemann-Pick disease type A
E75.241 Niemann-Pick disease type B
E75.242 Niemann-Pick disease type C
E75.243 Niemann-Pick disease type D
E75.244 Niemann-Pick disease type A/B
E75.248 Other Niemann-Pick disease
E75.249 Niemann-Pick disease, unspecified
E75.3 Sphingolipidosis, unspecified
E75.5 Other lipid storage disorders
E75.6 Lipid storage disorder, unspecified
E77.0 Defects in post-translational modification of lysosomal enzymes
E77.8 Other disorders of glycoprotein metabolism
E77.9 Disorder of glycoprotein metabolism, unspecified
E78.00 Pure hypercholesterolemia, unspecified
E78.01 Familial hypercholesterolemia
E78.1 Pure hyperglyceridemia
E78.2 Mixed hyperlipidemia
E78.3 Hyperchylomicronemia
E78.41 Elevated Lipoprotein(a)
E78.49 Other hyperlipidemia
E78.5 Hyperlipidemia, unspecified
E78.70 Disorder of bile acid and cholesterol metabolism, unspecified
E78.79 Other disorders of bile acid and cholesterol metabolism
E78.81 Lipoid dermatoarthritis
E78.89 Other lipoprotein metabolism disorders
E78.9 Disorder of lipoprotein metabolism, unspecified
E88.1 Lipodystrophy, not elsewhere classified
E88.2 Lipomatosis, not elsewhere classified
E88.89 Other specified metabolic disorders
I10 Essential (primary) hypertension
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I42.0 Dilated cardiomyopathy
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I51.9 Heart disease, unspecified
I52 Other heart disorders in diseases classified elsewhere
I63.011 Cerebral infarction due to thrombosis of right vertebral artery
I63.012 Cerebral infarction due to thrombosis of left vertebral artery
I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.02 Cerebral infarction due to thrombosis of basilar artery
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.09 Cerebral infarction due to thrombosis of other precerebral artery
I63.111 Cerebral infarction due to embolism of right vertebral artery
I63.112 Cerebral infarction due to embolism of left vertebral artery
I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries
I63.12 Cerebral infarction due to embolism of basilar artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.133 Cerebral infarction due to embolism of bilateral carotid arteries
I63.19 Cerebral infarction due to embolism of other precerebral artery
I63.211 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery
I63.212 Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery
I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries
I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar artery
I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries
I63.29 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I63.9 Cerebral infarction, unspecified
I67.858 Other hereditary cerebrovascular disease
I70.0 Atherosclerosis of aorta
I70.1 Atherosclerosis of renal artery
I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.208 Unspecified atherosclerosis of native arteries of extremities, other extremity
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.218 Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.228 Atherosclerosis of native arteries of extremities with rest pain, other extremity
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I70.25 Atherosclerosis of native arteries of other extremities with ulceration
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.268 Atherosclerosis of native arteries of extremities with gangrene, other extremity
I70.291 Other atherosclerosis of native arteries of extremities, right leg
I70.292 Other atherosclerosis of native arteries of extremities, left leg
I70.293 Other atherosclerosis of native arteries of extremities, bilateral legs
I70.298 Other atherosclerosis of native arteries of extremities, other extremity
I70.301 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, right leg
I70.302 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, left leg
I70.303 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, bilateral legs
I70.308 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity
I70.311 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.312 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.313 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.318 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.321 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, right leg
I70.322 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, left leg
I70.323 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.328 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, other extremity
I70.331 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of thigh
I70.332 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of calf
I70.333 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of ankle
I70.334 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.335 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.8 Atherosclerosis of other arteries
I70.90 Unspecified atherosclerosis
I70.91 Generalized atherosclerosis
I70.92 Chronic total occlusion of artery of the extremities
R00.2 Palpitations
R07.1 Chest pain on breathing
R07.2 Precordial pain
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
Z13.6 Encounter for screening for cardiovascular disorders
Z86.711 Personal history of pulmonary embolism
Z86.718 Personal history of other venous thrombosis and embolism
Z86.72 Personal history of thrombophlebitis
Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
Z86.74 Personal history of sudden cardiac arrest
Z86.79 Personal history of other diseases of the circulatory system

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

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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.

CodeDescription
999x Not Applicable

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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N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2021 R3

Under ICD-10 Codes that Support Medical Necessity Group 1: codes added E75.249, E77.9, E78.49, I63.39.  Codes added to correct typographical error.

10/01/2021 R2

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted I48.91, I63.00, I63.019, I63.039, I63.10, I63.119, I63.139, I63.20, I63.219, I63.239, I63.30, I63.319, I63.329, I63.339, I63.349, I63.40, I63.419, I63.429, I63.439, I63.449, I63.50, I63.519, I63.529, I63.539, I63.549, I70.209, I70.219, I70.229, I70.239, I70.249, I70.269, I70.299, I70.309, I70.319, I70.329. This revision will become effective 10/1/21.

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added E75.244. This revision is due to the Annual ICD-10 update and is effective on 10/1/21.

Under Article Text: Removal of claim information.

10/01/2019 R1

10/01/2019: This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related MolDX: Biomarkers in Cardiovascular Risk Assessment LCD and placed in this article.

Associated Documents

Related National Coverage Documents
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Rules and Regulations URLs
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Updated On Effective Dates Status
01/14/2022 10/01/2021 - N/A Currently in Effect You are here
12/28/2021 10/01/2021 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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