CYP2B6 Test Coding and Billing Guidelines (CM00046)
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October 20, 2015

CYP2B6 Test Coding and Billing Guidelines (CM00046)

Although recent studies indicate CYP2B6 may be useful to monitor drug metabolism, to date a comprehensive review has not established the clinical significance of this enzyme. Therefore, CYP2B6 testing does not meet the clinical utility requirements for a Medicare Benefit and is considered a statutorily excluded service. MolDX will also deny panels of tests that include the CYP2B6 gene.

To receive a CYP2B6 service denial, please submit the following claim information:

CPT code 81479

An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services

For a voluntary issued ABN, append with GX modifier

To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier

Select the appropriate diagnosis for the patient

Enter the appropriate identifier adjacent to the CPT code in the comment/narrative field for the following claim field/types:

Loop 2300 NTE01 for Part a or Loop 2400 or SV101-7 for the 5010A1 837P for Part B

Form locator 80 for Part A or Box 19 for Part B paper claim

Reference: Sec. 1862 (1)(A) Statutory Exclusion covers diagnostic testing "except for items and services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member,…"

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