Aspartoacyclase 2 Deficiency(ASPA) Testing Coding and Billing Guidelines (CM00088, V3)
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October 13, 2017

Aspartoacyclase 2 Deficiency(ASPA) Testing Coding and Billing Guidelines (CM00088, V3)

Effective for dates of service on and after February 7, 2013.

Asparoacyclase 2 Deficiency (ASPA) Testing, also known as Canavan Disease, is an autosomal recessive degenerative disorder that causes progressive nerve damage to nerve cells in the brain. Genetic testing identifies parents that may be at risk for conceiving a child with the disease and offspring suspected to have or diagnosed with the disease. Therefore, MolDX has determined that testing for the ASPA is not a Medicare benefit and is a statutorily excluded test. MolDX will also deny panels that include ASPA testing.

To receive an ASPA service denial, please submit the following claim information:

  • Select one of the following CPT codes for the performed service:
    • CPT code 81200 – ASPA, common variant
    • CPT code 81412 – Ashkenazi Jewish associated disorders
    • CPT code 81479 – Unlisted molecular pathology procedures
  • An Advance Beneficiary Notice of Non-Coverage (ABN) is not required for statutorily excluded services.
    • For a voluntary issued ABN, append with HCPCS modifier GX
    • To indicate a valid ABN is on file for a known statutorily excluded service, append with HCPCS modifier GY
  • Select the appropriate diagnosis for the patient
  • Enter the appropriate DEX Z-code™ identifier adjacent to the CPT code in the comment/narrative field for the following claim field/types:
    • Part A: Line SV202-7 (electronic claim); Form Locator 80 (paper claim)
    • Part B: Loop 2400 or SV101-7 (electronic claim); Item 19 (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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