9p21 Genotype Test Coding and Billing Guidelines (CM00041)
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October 20, 2015

9p21 Genotype Test Coding and Billing Guidelines (CM00041)

The MolDX Team has completed a review on the 9p21 Genotype test. To date, there is insufficient evidence to support the required clinical utility for the established Medicare benefit category. Therefore, the 9p21 test is a statutorily excluded test.

To receive a 9p21 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 statutorily excluded service, append with a GY modifier

Select the appropriate diagnosis for the patient

Enter the appropriate Identifier adjacent to each code in the stack in the comment/narrative field for the following claim field/types:

Loop 2300 NTE 01 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

For paper claims only one test per claim may be submitted

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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