TECHNICAL NOTICE. The CPT coding in this notice is effective January 1, 2013 and replaces the coding currently in use for these assays
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1 TECHNICAL NOTICE The CPT coding in this notice is effective January 1, 2013 and replaces the coding currently in use for these assays December 2012 The notation (MAAA) indicates "Multianalyte Assay with Algorithmic Analyses" which comprise a new subsection of the CPT code set for Some payers, including Medicare, will not recognize these MAAA codes for payment and will continue to require the individual CPTs for each analyte in the analysis. Consult the payer being billed to determine which CPT code(s) to use for these tests. SBMF Acetylcholine Receptor Blocking Antibody Acetylcholine Receptor Modulating Antibody ADmark Alzheimers Evaluation 81401; 83520x ADmark ApoE Genotype Analysis and Interpretation (Symptomatic) Alpha Thalassemia (HBA1 and HBA2) 7 Deletions Alpha-1-Antitrypsin (SERPINA1) Enzyme Concentration and ; Mutations with A1AT Phenotype if Indicated Angelman Syndrome and Prader-Willi Syndrome, Methylation Apolipoprotein E (APOE) 2 Mutations, Cardiovascular Risk Ashkenazi Jewish Diseases (BLM, ASPA, IKBKAP, FANCC, GBA, MCOLN1, SMPD1, HEXA) ; 81209; 81242; 81251; 81255; 81260; 81290; B-Cell and T-Cell Gene Rearrangement, PCR 81261; 81264; 81340; B-Cell Gene Rearrangement, PCR 81261; BCR/ABL Gene Detection, Qualitative RT-PCR, Diagnostic Assay 81206; BCR/ABL Gene Major Breakpoint (p210), Quantitative RT-PCR, Monitoring Assay BCR/ABL Gene Minor Breakpoint (p190), Quantitative RT-PCR, Monitoring Assay BCR-ABL1 Kinase Domain Mutation Analysis Beta Globin (HBB) HbS, HbC, and HbE Mutations 81401
2 44978 Beta Globin (HBB) Sequencing BIRC2-MALT1 (API2-MALT1) Translocation, t(11;18), RT-PCR Celiac-Associated HLA-DQ Typing, PCR 81376x Circulating Tumor Cell Count Clomipramine and Metabolite, Serum or Plasma Congenital Bilateral Absence of the Vas Deferens, Cystic Fibrosis Mutation Panel Connexin 26 (GJB2), Sequencing Cystic Fibrosis (CFTR) Mutation Panel Cystic Fibrosis (CFTR), Sequencing Cytochrome P450 2C19 (CYP2C19), 9 Mutations Cytochrome P450 2C9 (CYP2C9), 2 Mutations Cytochrome P450 2D6 (CYP2D6), 14 Mutations and Gene Duplication Epidermal Growth Factor Receptor (EGFR) Mutation Analysis 81235; Epidermal Growth Factor Receptor (EGFR) Mutation Analysis with 81235; ALK Rearrangement FISH if Indicated Factor V Leiden Mutation Analysis Factor V R2 DNA Test Familial Mediterranean Fever (MEFV) Sequencing Familial Mutation, Targeted Sequencing VARIES Fanconi Anemia, Group C (FANCC) 2 Mutations Fluoxetine and Metabolite, Serum or Plasma Fragile X Syndrome DNA Testing, Southern Blot and PCR 81243; Galactosemia (GALT) 9 Mutations Galactosemia (GALT) Enzyme Activity and 9 Mutations 81401; Hearing Loss, Nonsyndromic Panel (GJB2) Sequencing, (GJB6) 2 Deletions and Mitochondrial DNA 2 Mutations 81252; 81254; Hearing Loss, Nonsyndromic, Connexin 26 (GJB2) 35delG Mutation Hearing Loss, Nonsyndromic, Connexin 30 (GJB6) 2 Deletions Hearing Loss, Nonsyndromic, Mitochondrial DNA 2 Mutations Hemochromatosis Mutation Detection (S65C, H63D, and C282Y), Hereditary Hepatitis B Virus Genotyping Hepatitis C Virus (HCV) FibroSURE 0001M (MAAA) Hereditary Hemorrhagic Telangiectasia (ACVRL1 and ENG) Hereditary Hemorrhagic Telangiectasia (ACVRL1 and ENG) Sequencing x2
3 44945 Hereditary Hemorrhagic Telangiectasia (ACVRL1 and ENG) Sequencing and x HLA Bone Marrow Transplantation Evaluation 81380x2; HLA-A Genotype HLA-A Sequencing HLA-ABC Sequencing HLA-B Genotype HLA-B Sequencing HLA-B*5701 Associated Variant Genotyping for Abacavir Sensitivity HLA-B27 Confirmatory Assay, RT-PCR HLA-C Genotype HLA-C Sequencing HLA-DQB Genotype HLA-DR Genotype HLA-DRB1 Sequencing HNPCC/Lynch Syndrome (MLH1) Sequencing and 81292; HNPCC/Lynch Syndrome (MSH2) Sequencing and 81295; HNPCC/Lynch Syndrome (MSH6) Sequencing and 81298; HNPCC/Lynch Syndrome (PMS2) Pseudogene Analysis (Reflex Orders Only) HNPCC/Lynch Syndrome (PMS2) Sequencing and 81317; 81319, with Pseudogene Analysis if Indicated HNPCC/Lynch Syndrome, Microsatellite Instability, PCR Huntington Disease DNA Testing IgVH Mutation Analysis, Sequencing Influenza Virus A and B and Respiratory Syncytial Virus (RSV) Panel, Qualitative RT-PCR Inosine Triphosphate (ITPA) and Interleukin 28 B (IL28B)-Associated x2 Variants, 4 SNPs Interleukin 28 B (IL28B)-Associated Variants, 2 SNPs JAK2 (V617F) Mutation Analysis JAK2 Exon 12 Mutation Analysis K-ras/BRAF Mutation Analysis 81210; Legius Syndrome (SPRED1) Sequencing and (NF1) Sequencing Exon ; (Exon 17) Marfan Syndrome, FBN1
4 45869 Marfan Syndrome, FBN1 Sequencing Marfan Syndrome, FBN1 Sequencing and 81408; Methylenetetrahydrofolate Reductase (MTHFR) Mutation Analysis Mitochondrial Disorders (108 Nuclear Genes) Sequencing 81403x2; 81404x2; 81405x5; 81406x3; Mitochondrial Disorders (mtdna) Sequencing 81403x2; Mitochondrial Disorders Panel (mtdna and 108 Nuclear Genes) Sequencing and 81403x2; 81404x2; 81405x5; 81406x3; x Mitochondrial Genome (mtdna and 108 Nuclear Genes) Multiple Endocrine Neoplasia Type 1 (MEN1) Multiple Endocrine Neoplasia Type 1 (MEN1) Sequencing Multiple Endocrine Neoplasia Type 1 (MEN1) Sequencing and 81404; Multiple Endocrine Neoplasia Type 2 (MEN2), RET Gene Mutations, Sequencing Multiple Endocrine Neoplasia, Type 2B (RET) 2 Mutations Narcolepsy-Associated HLA Typing, PCR NASH Fibrosure 0003M (MAAA) Neurofibromatosis Type 1 (NF1) Noonan Syndrome (PTPN11) Sequencing Noonan Syndrome (PTPN11) Sequencing with (SOS1) Sequencing if Indicated Noonan Syndrome (SOS1) Sequencing OVA (MAAA) Pancreatitis, Hereditary (PRSS1) Sequencing Pancreatitis, Idiopathic (CFTR, PRSS1, SPINK1) Sequencing 81223; 81404; Pancreatitis, Idiopathic (SPINK1) Sequencing PCA3 - Prostate Cancer Biomarker Plasminogen Activator Inhibitor-1 4G/5G Polymorphism Detection Platelet Antigen 1 Genotyping (HPA-1) Platelet Antigen 15 Genotyping (HPA-15) Platelet Antigen 2 Genotyping (HPA-2) Platelet Antigen 3 Genotyping (HPA-3) Platelet Antigen 4 Genotyping (HPA-4) Platelet Antigen 5 Genotyping (HPA-5) 81400
5 45438 Platelet Antigen 6 Genotyping (HPA-6) Platelet Antigen Genotyping Panel 81400x PML/RARa, t(15;17) Translocation, Quantitative RT-PCR Prenatal Risk Assessment, First Trimester Screen (With NT) (MAAA) Prenatal Risk Assessment, Penta Screen (MAAA) Prenatal Risk Assessment, Quadruple Marker (MAAA) Prenatal Risk Assessment, Sequential Screening, Part 1 (First (MAAA) Trimester; With NT) Prenatal Risk Assessment, Sequential Screening, Part 2 (Second (MAAA) Trimester; With NT) Prenatal Risk Assessment, Serum Integrated Screening, Part (MAAA) (Second Trimester; Without NT) Prenatal Risk Assessment, Triple Marker (MAAA) PROMETHEUS Crohn s Prognostic 81401; 83520x5; 88347x PROMETHEUS IBD sgi Diagnostic x4; 82397x3; 83520x8; 86140; 88347x PROMETHEUS NOD2/CARD PROMETHEUS TPMT Genetics Prothrombin IgG and IgM Antibodies 86849x Prothrombin IgG Antibody Prothrombin IgM Antibody Prothrombin Nucleotide G/A Gene Mutation (Factor II) PTEN-Related Disorders (PTEN) PTEN-Related Disorders (PTEN) Sequencing PTEN-Related Disorders (PTEN) Sequencing and 81321; Respiratory Pathogens Panel, Qualitative RT-PCR Rett Syndrome (MECP2), Deletion and Duplication Rett Syndrome (MECP2), Full Gene Analysis 81302; Rett Syndrome (MECP2), Full Gene Sequencing RUNX1-RUNX1T1 (AML1-ETO) Translocation, t(8;21), RT-PCR SCN1A-Related Seizure Disorders (SCN1A), Sequencing and 81407; Septin 9 (SEPT9), Methylated DNA Detection, Real-Time PCR STRATIFY JCV Antibody Inhibition Assay (Reflex Orders Only) STRATIFY JCV Antibody with Inhibition Assay if Indicated T-Cell Gene Rearrangement, PCR 81340; 81342
6 36131 Thrombosis DNA Mutations Panel 81240; 81241; Twin Zygosity Testing UDP Glucuronosyltransferase 1A1 (UGT1A1) Genotyping Very Long-Chain Acyl-CoA Dehydrogenase Deficiency (ACADVL) Very Long-Chain Acyl-CoA Dehydrogenase Deficiency (ACADVL) Sequencing Very Long-Chain Acyl-CoA Dehydrogenase Deficiency (ACADVL) 81406; Sequencing and von Hippel-Lindau (VHL) von Hippel-Lindau (VHL) Sequencing von Hippel-Lindau (VHL) Sequencing and 81403; Warfarin Sensitivity (CYP2C9 and VKORC1), 3 Mutations ; X Chromosome Ultra-High Density Microarray, 954 Genes Y Chromosome Microdeletion Please direct any questions, or comments regarding this notice to Robert J. Tomec, M.D. (rtomec@sbmf.org) or Diane Janowiak (djanowiak@sbmf.org) or call South Bend Medical Foundation, (574) or (800)
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JOHNS HOPKINS HEALTHCARE. Medical Policy: Genetic Testing Department: Health Services Lines of Business: EHP, USFHP, PPMCO, ADVANTAGE MD
Page 1 of 28 ACTION: New Policy: Effective Date: 08/26/2003 Revising : Review Dates: 03/15/04, 10/22/04, 10/21/05, Superseding : 10/19/06, 01/07/08, 01/05/09, 01/07/11, 06/07/13, Archiving : 06/05/15,
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