CPT Codes for Pharmacogenomic Tests

Transcription

1 CPT s for Pharmacogenomic Tests The table below lists CPT codes and lab fee information for pharmacogenomic tests as established by the Centers for Medicare and Medicaid Services. It was compiled by the IGNITE Clinical Validity, Utility, and Economics Working Group. Perm X30 CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, (eg, *2, *22) germline or Rationale NLA Meeting Notes B*27), each to query 2 SNPs are 2 X (6); (3) (NLA - $176.03) 1

2 X X32 CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, common (eg, *2, *3,*4, *5 *6, *7) DPYD (dihydropyrimidine (eg, 5- fluorouracil/5-fu and capecitabine (eg, *2A, *4, *5, *6) germline or germline or Rationale NLA Meeting Notes CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug (eg, *2, *3, *4, *8, *17) CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9)(eg, drug (eg. *2, *3, *5, *6) to test 6 SNPS in CYP3A5 are comparable to those used to query 5 SNPS in CYP2C19. to query 4 SNPs are comparable across both assays. $ $ (7); (2) (8); (1) (NLA - $176.03) 2

3 X X X40 (eg, A, A-) known familial variant(s) full gene sequence (13 exons) genetic by genotyping for single nucleotide variant (SNV); Multiplexed Ligationdependent Probe Amplification (MLPA) for del/dup genetic by genotyping for SNV; MLPA for del/dup (two tested in affected females) genetic s: bi-directional sequencing of coding regions as well as exonintron junctions by Sanger sequencing or next generation sequencing Rationale NLA Meeting Notes B*27) BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) known familial variant PTEN (phosphatase and tensin homolog) (eg, cowden syndrome, PTEN hamartoma tumor syndrome) full gene analysis. and materials employed to query 2 SNPs are used and the deletion and substitution types of tested for are both for BRCA1 known familial variant. used for sequencing and the amount of DNA sequenced for G6PD both for PTEN (priced by gapfill). $93.75 $ X 2 (3); (3); (3) (NLA of is $ and was the ACLA rec) (9) (6); (3) ($58.72) ($152.54) 3

4 X X34 IFNL3 (interferon, lambda 3) (eg, drug response), rs variant SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), (eg, *5) germline or germline or Rationale NLA Meeting Notes F5 (coagulation Factor V) (eg, hereditary hypercoagulability) Leiden variant HLA Class II typing, low resolution, one locus (eg, HLA- DRB1, -DRB3/4/5, - DQB1, -DQA1, - DPB1, or DPA1), each to detect the type of point mutation tested for in the IFNL3 gene are for F5. to detect one SNP in the SLCO1B1 gene are comparable to that for HLA class II typing. $83.82 $ (8); (2) (7); (2) ($58.72) 4

5 X X36 TPMT (thiopurine S- methyltransferase) (eg, drug (eg, *2, *3) TYMS (thymidylate synthetase) (eg, 5- fluorouracil/5-fu (eg, tandem repeat variant) germline or germline or Rationale NLA Meeting Notes B*27), each FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis, internal tandem duplication (ITD) (ie, exons 14, 15) to query 2 SNPs are (eg, PCR followed by CE analysis) and materials used are comparable for the detection of each of these tandem repeat. $ (5); (4) (9) 5