SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: Proteomics Testing

A59646

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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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Article ID
A59646
Original ICD-9 Article ID
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Article Title
Billing and Coding: MolDX: Proteomics Testing
Article Type
Billing and Coding
Original Effective Date
01/31/2024
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Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manuals, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 A/B MAC (B) Contacts With Independent Clinical Laboratories

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CMS Internet-Only 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: Molecular Diagnostic Tests (MDT) L36021.

Proteins are common analytes and a staple of clinical laboratory testing. Tests measuring proteins are typically found across all CPT Pathology and Laboratory code sets, except for Molecular Pathology (CPT 81105-81408), which is the general scope of the MolDX program.

With advances in laboratory testing, more complex services utilizing proteins have developed. Many of these tests are multianalyte tests that seek to measure more than the presence or absence of expression of any given protein or groups of proteins. The term “proteomics” is commonly used for such tests.

Proteomics tests are hereby defined by this contractor as those tests that seek to measure the structure, function, interactions, and compositions of proteins for the sake of understanding cellular interactions of the patient in relation to disease or therapeutic interventions. These services may include the measurement of other, non-protein analytes as part of this process. Of note, it is the interaction of proteins and other analytes that is the essential component of a proteomics test, and not the presence, structure or expression of individual proteins.

To be considered a proteomics test, a test must:

  • Be a multianalyte test that includes proteins as the major or essential analytes;
  • Measure the interactions between analytes, including proteins;
  • Require the use of informatics (nomograms, rubrics, or algorithms) to yield a result;
  • Demonstrate the clinical validity of the assay as a function of the interaction of analytes measured

A test is not considered a proteomics test if:

  • The clinical validity of the test rests with the analytes measured directly and not the interactions of analytes measured as an output of the informatic approach;
  • Is better defined as a genomics test, with DNA and RNA components as the majority or essential analytes measured;
  • The protein analytes measured are not necessary for the clinical validity of the result

Proteomics tests as defined above must be billed with an appropriate CPT code. These may be found in the Multianalyte CPT code set or may utilize the NOC code 81599; or may be defined by a relevant PLA code.

Given the complexity of these tests and the ambiguity of services rendered, all proteomics tests in MolDX jurisdictions must register with the DEX® Diagnostics Exchange Registry and obtain a Z-Code® identifier. To determine if the submitted tests are compliant with relevant policy requirements, these tests will undergo Technical Assessment by Palmetto GBA as part of the MolDX program. This is effective 1/31/2024.

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

  • Select 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

NOTE: When entering the DEX Z-Code® on the SV101-7 documentation field for Part B claims please do not add additional characters and/or information on the line.

Response To Comments

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Coding Information

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CPT/HCPCS Codes

Group 1

(45 Codes)
Group 1 Paragraph

The codes listed below fall within scope of the associated policy but do not automatically imply coverage.

Group 1 Codes
Code Description
81490 AUTOIMMUNE (RHEUMATOID ARTHRITIS), ANALYSIS OF 12 BIOMARKERS USING IMMUNOASSAYS, UTILIZING SERUM, PROGNOSTIC ALGORITHM REPORTED AS A DISEASE ACTIVITY SCORE
81500 ONCOLOGY (OVARIAN), BIOCHEMICAL ASSAYS OF TWO PROTEINS (CA-125 AND HE4), UTILIZING SERUM, WITH MENOPAUSAL STATUS, ALGORITHM REPORTED AS A RISK SCORE
81503 ONCOLOGY (OVARIAN), BIOCHEMICAL ASSAYS OF FIVE PROTEINS (CA-125, APOLIPOPROTEIN A1, BETA-2 MICROGLOBULIN, TRANSFERRIN, AND PRE-ALBUMIN), UTILIZING SERUM, ALGORITHM REPORTED AS A RISK SCORE
81517 LIVER DISEASE, ANALYSIS OF 3 BIOMARKERS (HYALURONIC ACID [HA], PROCOLLAGEN III AMINO TERMINAL PEPTIDE [PIIINP], TISSUE INHIBITOR OF METALLOPROTEINASE 1 [TIMP-1]), USING IMMUNOASSAYS, UTILIZING SERUM, PROGNOSTIC ALGORITHM REPORTED AS A RISK SCORE AND RISK OF LIVER FIBROSIS AND LIVER-RELATED CLINICAL EVENTS WITHIN 5 YEARS
81539 ONCOLOGY (HIGH-GRADE PROSTATE CANCER), BIOCHEMICAL ASSAY OF FOUR PROTEINS (TOTAL PSA, FREE PSA, INTACT PSA, AND HUMAN KALLIKREIN-2 [HK2]), UTILIZING PLASMA OR SERUM, PROGNOSTIC ALGORITHM REPORTED AS A PROBABILITY SCORE
81599 UNLISTED MULTIANALYTE ASSAY WITH ALGORITHMIC ANALYSIS
0002M LIVER DISEASE, TEN BIOCHEMICAL ASSAYS (ALT, A2-MACROGLOBULIN, APOLIPOPROTEIN A-1, TOTAL BILIRUBIN, GGT, HAPTOGLOBIN, AST, GLUCOSE, TOTAL CHOLESTEROL AND TRIGLYCERIDES) UTILIZING SERUM, PROGNOSTIC ALGORITHM REPORTED AS QUANTITATIVE SCORES FOR FIBROSIS, STEATOSIS AND ALCOHOLIC STEATOHEPATITIS (ASH)
0003M LIVER DISEASE, TEN BIOCHEMICAL ASSAYS (ALT, A2-MACROGLOBULIN, APOLIPOPROTEIN A-1, TOTAL BILIRUBIN, GGT, HAPTOGLOBIN, AST, GLUCOSE, TOTAL CHOLESTEROL AND TRIGLYCERIDES) UTILIZING SERUM, PROGNOSTIC ALGORITHM REPORTED AS QUANTITATIVE SCORES FOR FIBROSIS, STEATOSIS AND NONALCOHOLIC STEATOHEPATITIS (NASH)
0015M ADRENAL CORTICAL TUMOR, BIOCHEMICAL ASSAY OF 25 STEROID MARKERS, UTILIZING 24-HOUR URINE SPECIMEN AND CLINICAL PARAMETERS, PROGNOSTIC ALGORITHM REPORTED AS A CLINICAL RISK AND INTEGRATED CLINICAL STEROID RISK FOR ADRENAL CORTICAL CARCINOMA, ADENOMA, OR OTHER ADRENAL MALIGNANCY
0019M CARDIOVASCULAR DISEASE, PLASMA, ANALYSIS OF PROTEIN BIOMARKERS BY APTAMER-BASED MICROARRAY AND ALGORITHM REPORTED AS 4-YEAR LIKELIHOOD OF CORONARY EVENT IN HIGH-RISK POPULATIONS
0002U ONCOLOGY (COLORECTAL), QUANTITATIVE ASSESSMENT OF THREE URINE METABOLITES (ASCORBIC ACID, SUCCINIC ACID AND CARNITINE) BY LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING ACQUISITION, ALGORITHM REPORTED AS LIKELIHOOD OF ADENOMATOUS POLYPS
0003U ONCOLOGY (OVARIAN) BIOCHEMICAL ASSAYS OF FIVE PROTEINS (APOLIPOPROTEIN A-1, CA 125 II, FOLLICLE STIMULATING HORMONE, HUMAN EPIDIDYMIS PROTEIN 4, TRANSFERRIN), UTILIZING SERUM, ALGORITHM REPORTED AS A LIKELIHOOD SCORE
0021U ONCOLOGY (PROSTATE), DETECTION OF 8 AUTOANTIBODIES (ARF 6, NKX3-1, 5'-UTR-BMI1, CEP 164, 3'-UTR-ROPPORIN, DESMOCOLLIN, AURKAIP-1, CSNK2A2), MULTIPLEXED IMMUNOASSAY AND FLOW CYTOMETRY SERUM, ALGORITHM REPORTED AS RISK SCORE
0080U ONCOLOGY (LUNG), MASS SPECTROMETRIC ANALYSIS OF GALECTIN-3-BINDING PROTEIN AND SCAVENGER RECEPTOR CYSTEINE-RICH TYPE 1 PROTEIN M130, WITH FIVE CLINICAL RISK FACTORS (AGE, SMOKING STATUS, NODULE DIAMETER, NODULE-SPICULATION STATUS AND NODULE LOCATION), UTILIZING PLASMA, ALGORITHM REPORTED AS A CATEGORICAL PROBABILITY OF MALIGNANCY
0092U ONCOLOGY (LUNG), THREE PROTEIN BIOMARKERS, IMMUNOASSAY USING MAGNETIC NANOSENSOR TECHNOLOGY, PLASMA, ALGORITHM REPORTED AS RISK SCORE FOR LIKELIHOOD OF MALIGNANCY
0095U EOSINOPHILIC ESOPHAGITIS, EOTAXIN-3 [CCL26 {C-C MOTIF CHEMOKINE LIGAND 26}] AND MAJOR BASIC PROTEIN [PRG2 {PROTEOGLYCAN 2, PRO EOSINOPHIL MAJOR BASIC PROTEIN}], ENZYME-LINKED IMMUNOSORBENT ASSAYS (ELISA), SPECIMEN OBTAINED BY ESOPHAGEAL STRING TEST DEVICE, ALGORITHM REPORTED AS PROBABILITY OF ACTIVE OR INACTIVE EOSINOPHILIC ESOPHAGITIS
0105U NEPHROLOGY (CHRONIC KIDNEY DISEASE), MULTIPLEX ELECTROCHEMILUMINESCENT IMMUNOASSAY (ECLIA) OF TUMOR NECROSIS FACTOR RECEPTOR 1A, RECEPTOR SUPERFAMILY 2 (TNFR1, TNFR2), AND KIDNEY INJURY MOLECULE-1 (KIM-1) COMBINED WITH LONGITUDINAL CLINICAL DATA, INCLUDING APOL1 GENOTYPE IF AVAILABLE, AND PLASMA (ISOLATED FRESH OR FROZEN), ALGORITHM REPORTED AS PROBABILITY SCORE FOR RAPID KIDNEY FUNCTION DECLINE (RKFD)
0117U PAIN MANAGEMENT, ANALYSIS OF 11 ENDOGENOUS ANALYTES (METHYLMALONIC ACID, XANTHURENIC ACID, HOMOCYSTEINE, PYROGLUTAMIC ACID, VANILMANDELATE, 5HYDROXYINDOLEACETIC ACID, HYDROXYMETHYLGLUTARATE, ETHYLMALONATE, 3HYDROXYPROPYL MERCAPTURIC ACID (3-HPMA), QUINOLINIC ACID, KYNURENIC ACID), LCMS/MS, URINE, ALGORITHM REPORTED AS A PAIN-INDEX SCORE WITH LIKELIHOOD OF ATYPICAL BIOCHEMICAL FUNCTION ASSOCIATED WITH PAIN
0174U ONCOLOGY (SOLID TUMOR), MASS SPECTROMETRIC 30 PROTEIN TARGETS, FORMALIN-FIXED PARAFFIN-EMBEDDED TISSUE, PROGNOSTIC AND PREDICTIVE ALGORITHM REPORTED AS LIKELY, UNLIKELY, OR UNCERTAIN BENEFIT OF 39 CHEMOTHERAPY AND TARGETED THERAPEUTIC ONCOLOGY AGENTS
0206U NEUROLOGY (ALZHEIMER DISEASE); CELL AGGREGATION USING MORPHOMETRIC IMAGING AND PROTEIN KINASE C-EPSILON (PKCE) CONCENTRATION IN RESPONSE TO AMYLOSPHEROID TREATMENT BY ELISA, CULTURED SKIN FIBROBLASTS, EACH REPORTED AS POSITIVE OR NEGATIVE FOR ALZHEIMER DISEASE
0207U NEUROLOGY (ALZHEIMER DISEASE); QUANTITATIVE IMAGING OF PHOSPHORYLATED ERK1 AND ERK2 IN RESPONSE TO BRADYKININ TREATMENT BY IN SITU IMMUNOFLUORESCENCE, USING CULTURED SKIN FIBROBLASTS, REPORTED AS A PROBABILITY INDEX FOR ALZHEIMER DISEASE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
0228U ONCOLOGY (PROSTATE), MULTIANALYTE MOLECULAR PROFILE BY PHOTOMETRIC DETECTION OF MACROMOLECULES ADSORBED ON NANOSPONGE ARRAY SLIDES WITH MACHINE LEARNING, UTILIZING FIRST MORNING VOIDED URINE, ALGORITHM REPORTED AS LIKELIHOOD OF PROSTATE CANCER
0249U ONCOLOGY (BREAST), SEMIQUANTITATIVE ANALYSIS OF 32 PHOSPHOPROTEINS AND PROTEIN ANALYTES, INCLUDES LASER CAPTURE MICRODISSECTION, WITH ALGORITHMIC ANALYSIS AND INTERPRETATIVE REPORT
0259U NEPHROLOGY (CHRONIC KIDNEY DISEASE), NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY MEASUREMENT OF MYO-INOSITOL, VALINE, AND CREATININE, ALGORITHMICALLY COMBINED WITH CYSTATIN C (BY IMMUNOASSAY) AND DEMOGRAPHIC DATA TO DETERMINE ESTIMATED GLOMERULAR FILTRATION RATE (GFR), SERUM, QUANTITATIVE
0263U NEUROLOGY (AUTISM SPECTRUM DISORDER [ASD]), QUANTITATIVE MEASUREMENTS OF 16 CENTRAL CARBON METABOLITES (IE, A-KETOGLUTARATE, ALANINE, LACTATE, PHENYLALANINE, PYRUVATE, SUCCINATE, CARNITINE, CITRATE, FUMARATE, HYPOXANTHINE, INOSINE, MALATE, S-SULFOCYSTEINE, TAURINE, URATE, AND XANTHINE), LIQUID CHROMATOGRAPHY-TANDEM MASS SPECTROMETRY (LC-MS/MS), PLASMA, ALGORITHMIC ANALYSIS WITH RESULT REPORTED AS NEGATIVE OR POSITIVE (WITH METABOLIC SUBTYPES OF ASD)
0295U ONCOLOGY (BREAST DUCTAL CARCINOMA IN SITU), PROTEIN EXPRESSION PROFILING BY IMMUNOHISTOCHEMISTRY OF 7 PROTEINS (COX2, FOXA1, HER2, KI-67, P16, PR, SIAH2), WITH 4 CLINICOPATHOLOGIC FACTORS (SIZE, AGE, MARGIN STATUS, PALPABILITY), UTILIZING FORMALIN-FIXED PARAFFIN-EMBEDDED (FFPE) TISSUE, ALGORITHM REPORTED AS A RECURRENCE RISK SCORE
0308U CARDIOLOGY (CORONARY ARTERY DISEASE [CAD]), ANALYSIS OF 3 PROTEINS (HIGH SENSITIVITY [HS] TROPONIN, ADIPONECTIN, AND KIDNEY INJURY MOLECULE-1 [KIM-1]) WITH 3 CLINICAL PARAMETERS (AGE, SEX, HISTORY OF CARDIAC INTERVENTION), PLASMA, ALGORITHM REPORTED AS A RISK SCORE FOR OBSTRUCTIVE CAD
0309U CARDIOLOGY (CARDIOVASCULAR DISEASE), ANALYSIS OF 4 PROTEINS (NT-PROBNP, OSTEOPONTIN, TISSUE INHIBITOR OF METALLOPROTEINASE-1 [TIMP-1], AND KIDNEY INJURY MOLECULE-1 [KIM-1]), PLASMA, ALGORITHM REPORTED AS A RISK SCORE FOR MAJOR ADVERSE CARDIAC EVENT
0310U PEDIATRICS (VASCULITIS, KAWASAKI DISEASE [KD]), ANALYSIS OF 3 BIOMARKERS (NT-PROBNP, C-REACTIVE PROTEIN, AND T-UPTAKE), PLASMA, ALGORITHM REPORTED AS A RISK SCORE FOR KD
0312U AUTOIMMUNE DISEASES (EG, SYSTEMIC LUPUS ERYTHEMATOSUS [SLE]), ANALYSIS OF 8 IGG AUTOANTIBODIES AND 2 CELL-BOUND COMPLEMENT ACTIVATION PRODUCTS USING ENZYME-LINKED IMMUNOSORBENT IMMUNOASSAY (ELISA), FLOW CYTOMETRY AND INDIRECT IMMUNOFLUORESCENCE, SERUM, OR PLASMA AND WHOLE BLOOD, INDIVIDUAL COMPONENTS REPORTED ALONG WITH AN ALGORITHMIC SLE-LIKELIHOOD ASSESSMENT
0322U NEUROLOGY (AUTISM SPECTRUM DISORDER [ASD]), QUANTITATIVE MEASUREMENTS OF 14 ACYL CARNITINES AND MICROBIOME-DERIVED METABOLITES, LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS), PLASMA, RESULTS REPORTED AS NEGATIVE OR POSITIVE FOR RISK OF METABOLIC SUBTYPES ASSOCIATED WITH ASD
0344U HEPATOLOGY (NONALCOHOLIC FATTY LIVER DISEASE [NAFLD]), SEMIQUANTITATIVE EVALUATION OF 28 LIPID MARKERS BY LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS), SERUM, REPORTED AS AT-RISK FOR NONALCOHOLIC STEATOHEPATITIS (NASH) OR NOT NASH
0351U INFECTIOUS DISEASE (BACTERIAL OR VIRAL), BIOCHEMICAL ASSAYS, TUMOR NECROSIS FACTORRELATED APOPTOSIS-INDUCING LIGAND (TRAIL), INTERFERON GAMMA-INDUCED PROTEIN-10 (IP10), AND C-REACTIVE PROTEIN, SERUM, OR VENOUS WHOLE BLOOD, ALGORITHM REPORTED AS LIKELIHOOD OF BACTERIAL INFECTION
0359U ONCOLOGY (PROSTATE CANCER), ANALYSIS OF ALL PROSTATE-SPECIFIC ANTIGEN (PSA) STRUCTURAL ISOFORMS BY PHASE SEPARATION AND IMMUNOASSAY, PLASMA, ALGORITHM REPORTS RISK OF CANCER
0360U ONCOLOGY (LUNG), ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA) OF 7 AUTOANTIBODIES (P53, NY-ESO-1, CAGE, GBU4-5, SOX2, MAGE A4, AND HUD), PLASMA, ALGORITHM REPORTED AS A CATEGORICAL RESULT FOR RISK OF MALIGNANCY
0365U ONCOLOGY (BLADDER), ANALYSIS OF 10 PROTEIN BIOMARKERS (A1AT, ANG, APOE, CA9, IL8, MMP9, MMP10, PAI1, SDC1 AND VEGFA) BY IMMUNOASSAYS, URINE, ALGORITHM REPORTED AS A PROBABILITY OF BLADDER CANCER
0366U ONCOLOGY (BLADDER), ANALYSIS OF 10 PROTEIN BIOMARKERS (A1AT, ANG, APOE, CA9, IL8, MMP9, MMP10, PAI1, SDC1 AND VEGFA) BY IMMUNOASSAYS, URINE, ALGORITHM REPORTED AS A PROBABILITY OF RECURRENT BLADDER CANCER
0367U ONCOLOGY (BLADDER), ANALYSIS OF 10 PROTEIN BIOMARKERS (A1AT, ANG, APOE, CA9, IL8, MMP9, MMP10, PAI1, SDC1 AND VEGFA) BY IMMUNOASSAYS, URINE, DIAGNOSTIC ALGORITHM REPORTED AS A RISK SCORE FOR PROBABILITY OF RAPID RECURRENCE OF RECURRENT OR PERSISTENT CANCER FOLLOWING TRANSURETHRAL RESECTION
0375U ONCOLOGY (OVARIAN), BIOCHEMICAL ASSAYS OF 7 PROTEINS (FOLLICLE STIMULATING HORMONE, HUMAN EPIDIDYMIS PROTEIN 4, APOLIPOPROTEIN A-1, TRANSFERRIN, BETA-2 MACROGLOBULIN, PREALBUMIN [IE, TRANSTHYRETIN], AND CANCER ANTIGEN 125), ALGORITHM REPORTED AS OVARIAN CANCER RISK SCORE
0384U NEPHROLOGY (CHRONIC KIDNEY DISEASE), CARBOXYMETHYLLYSINE, METHYLGLYOXAL HYDROIMIDAZOLONE, AND CARBOXYETHYL LYSINE BY LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) AND HBA1C AND ESTIMATED GLOMERULAR FILTRATION RATE (GFR), WITH RISK SCORE REPORTED FOR PREDICTIVE PROGRESSION TO HIGH-STAGE KIDNEY DISEASE
0385U NEPHROLOGY (CHRONIC KIDNEY DISEASE), APOLIPOPROTEIN A4 (APOA4), CD5 ANTIGEN-LIKE (CD5L), AND INSULIN-LIKE GROWTH FACTOR BINDING PROTEIN 3 (IGFBP3) BY ENZYME-LINKED IMMUNOASSAY (ELISA), PLASMA, ALGORITHM COMBINING RESULTS WITH HDL, ESTIMATED GLOMERULAR FILTRATION RATE (GFR) AND CLINICAL DATA REPORTED AS A RISK SCORE FOR DEVELOPING DIABETIC KIDNEY DISEASE
0387U ONCOLOGY (MELANOMA), AUTOPHAGY AND BECLIN 1 REGULATOR 1 (AMBRA1) AND LORICRIN (AMLO) BY IMMUNOHISTOCHEMISTRY, FORMALIN-FIXED PARAFFIN-EMBEDDED (FFPE) TISSUE, REPORT FOR RISK OF PROGRESSION
0407U NEPHROLOGY (DIABETIC CHRONIC KIDNEY DISEASE [CKD]), MULTIPLEX ELECTROCHEMILUMINESCENT IMMUNOASSAY (ECLIA) OF SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR 1 (STNFR1), SOLUBLE TUMOR NECROSIS RECEPTOR 2 (STNFR2), AND KIDNEY INJURY MOLECULE 1 (KIM-1) COMBINED WITH CLINICAL DATA, PLASMA, ALGORITHM REPORTED AS RISK FOR PROGRESSIVE DECLINE IN KIDNEY FUNCTION
0415U CARDIOVASCULAR DISEASE (ACUTE CORONARY SYNDROME [ACS]), IL-16, FAS, FASLIGAND, HGF, CTACK, EOTAXIN, AND MCP-3 BY IMMUNOASSAY COMBINED WITH AGE, SEX, FAMILY HISTORY, AND PERSONAL HISTORY OF DIABETES, BLOOD, ALGORITHM REPORTED AS A 5-YEAR (DELETED RISK) SCORE FOR ACS
0436U ONCOLOGY (LUNG), PLASMA ANALYSIS OF 388 PROTEINS, USING APTAMER-BASED PROTEOMICS TECHNOLOGY, PREDICTIVE ALGORITHM REPORTED AS CLINICAL BENEFIT FROM IMMUNE CHECKPOINT INHIBITOR THERAPY
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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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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
04/05/2024 04/01/2024 - N/A Currently in Effect View
02/21/2024 01/31/2024 - 03/31/2024 Superseded View
12/27/2023 01/31/2024 - N/A Superseded You are here

Keywords

  • Proteomics
  • Proteomics Testing