March 22, 2013
Aspartoacyclase (ASPA) 2 Deficiency Testing: Coding and Claims Submission Guidelines
Asparoacyclase 2 Deficiency, 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. CGS has determined that Asparatoacyclase 2 deficiency testing is not a Medicare benefit and is a statutorily excluded test.
The following Aspartoacyclase 2 deficiency tests have been identified as non-covered:
| Test |
|---|
| Canavan (ASPA) 4 Mutations, Fetal |
| Canavan Disease (ASPA) 4 Mutations |
| Canavan Disease |
| Canavan Disease, Mutation Analysis, ASPA |
| Canavan Disease Targeted Mutation Analysis |
Health care providers are not required to submit claims to Medicare for statutorily non-covered services; however, you may choose to submit claims (e.g., at the patient's request). Claims for Aspartoacyclase 2 deficiency tests must include:
- For dates of service prior to January 1, 2013: use the appropriate CPT code stack for the test
- For dates of on or after January 1, 2013: CPT code 81200
- HCPCS modifier GY (statutorily non-covered service)
- The appropriate ICD-9-CM code(s)
- The name of the test (ASPA ):
- Electronic claims : Loop 2400, NTE02, or SV101-7 field
- Paper claims: Box 19
Reference:
- Definition of "reasonable and medically necessary": Social Security Act, section 1862(a)(1)(A)
- Exception to mandatory claim submission for "categorically excluded services": CMS MLN Matters article SE0908, "Mandatory Claims Submission and Its Enforcement"
- Guidance on issuing Advance Beneficiary Notices of Noncoverage (ABNs) on a voluntary basis for statutorily excluded services: CMS Beneficiary Notices Initiative Web page – Fee-For-Service (FFS) ABN
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