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Molecular Pathology (MoPath): Reimbursement for Unlisted Molecular Pathology CPT Code 81479

As instructed by CMS, CGS has determined a gap fill allowance for the 2013 unlisted molecular pathology CPT code (81479), depending on the test being submitted. This is not an all-inclusive list and will be updated as new test(s) are reviewed for coverage.

Claim Submission

All services to produce the assay result were evaluated and included in the listed fee. CGS has included the coverage determination established during the review of available literature. We will continue to update this fee schedule as additional MoPath services are evaluated.

  • Please include the name of the test:
    • Electronic Claims: Loop 2400, NTE02, or SV101-7 field
    • Paper Claims: Block 19
    • If the name of the test is not included on the claim and HCPCS modifier GY is not submitted, the claim will be rejected as unprocessable (remark code MA130). Rejected claims must be corrected and resubmitted as new claims.

Reference:

Note: In covered column, Y=covered and N=non-covered

CPT Code Descriptor CGS-LDT Covered Comment
81479 VIM (Vimentin) $0 N Article published
81479 NAT-2 (N-acetyltransferase 2 (arylamine N-acetyltransferase) $0 N Article published
81479 SULT4A1 (sulfotransferase family 4A, member 1) $0 N Article published
81479 SLC01B1 (Solute Carrier organic Anion Transporter family, member 1B1) $0 N Article published
81479 CertNDx (this includes TWIST-1, NID-2, MMP-2) $0 N Article published
81479 ARVC Sequencing Panel (Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy) $0 N Article published
81479 L1CAM gene sequencing $0 N Article published
81479 Comprehensive Mitochondrial Nuclear Gene Panel or Mitochondrial Genome Sequence $0 N Article published
81479 PAX6 Gene Sequencing (WAGR syndrome) $0 N Article published
81479 HAX1 Gene Sequencing or ELA2 gene analysis (Kostmann disease and congenital neutropenia) $0 N Article published
81479 PreDx Diabetes Risk Score (DRS) $0 N Article published
81479 Pervenio Lung RS Assay $0 N Article published
81479 Know Error DNA Specimen Provenance Assay $0 N Article published
81479 BluePrint $0 N Article published
81479 ADRA2A (adrenoceptor alpha 2A) $0 N Article published
81479 SLC6A4 (solute carrier family 6 (neurotransmitter transporter, serotonin), member 4) $0 N Article published
81479 HTR2A (5-hydroxytryptamine (serotonin) receptor 2A, G protein-coupled) $0 N Article published
81479 COMT (catechol-O-methyltransferase) $0 N Article published
81479 CYP1A2 (cytochrome P450, family 1, subfamily A, polypeptide 2) $0 N Article published
81479 OPRM1 (opioid receptor, mu 1) $0 N Article published
81479 CHD7 Gene Sequencing $0 N Article published
81479 HTTLPR Gene Testing – Serotonin Transporter genotyping $0 N Article published

Revised: 08.12.13

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