July 26, 2013 – Revised: December 22, 2014
BCR-ABL Coding and Billing Guidelines Update
Effective for services performed on or after 11/3/2014, coverage requirements for this test is addressed in CGS's Local Coverage Determination (LCD) for Molecular Diagnostic Tests (L35394). The instructions in this article apply to services provided before this date.
Effective for dates of service on and after April 15, 2013.
Breakpoint testing for BCR-ABL1 is commonly performed as a combination or panel of tests. To report multiple tests assigned a single CPT code, submit CPT code 81479 and identify the individual test as instructed below. This guideline includes the following ©CPT code combinations:
- 81206 and 81207
- 81206, 81207, and 81208
CPT codes 81206, 81207, and 81208 may only be reported when performed as a single test. When a panel is performed, submit CPT code 81479, as explained in this article.
To identify individual tests performed as a panel, please report as indicated below, with the test name and any abbreviations as indicated. Claims must contain the following:
- CPT code 81479
- The appropriate ICD-9-CM code(s)
- Name of the test listed as indicated below.
- Electronic Claims: Loop 2400, NTE02, or SV101-7 field
- Paper Claims: Block 19
Test | CPT Code | |
---|---|---|
1. | BCR-ABL t(9;22) Quantitative GenoTRACE Assay | 81479 |
2. | BCR/ABL, Quantitative, t(9;22) for CML, ALL | 81479 |
3. | Qualitative w/ reflex to BCR-ABL1 | 81479 |
4. | BCR-ABL, t(9;22) Translocation Qualitative by RT-PCR | 81479 |
5. | BCR/ABL t(9;22) Quantification | 81479 |
6. | BCR/ABL Qualitative PCR | 81479 |
7. | BCR/ABL, mRNA Detection, Reverse Transcription-PCR (RT-PCR), Qualitative, Diagnostic Assay | 81479 |
8. | BCR/ABL quantitative | 81479 |
9. | BCR/ABL qualitative | 81479 |
10. | Qualitative BCR-ABL, Blood | 81479 |
11. | Qualitative BCR-ABL, Bone Marrow | 81479 |
12. | Qualitative BCR-ABL, Tissue | 81479 |
13. | Quantitative BCR-ABL, Blood | 81479 |
14. | Quantitative BCR-ABL, Bone Marrow | 81479 |
15. | Quantitative BCR-ABL, Fluid | 81479 |
16. | Molecular t(9;22) RT-PCR | 81479 |
17. | BCR/ABL1 ANALYSIS QUANTITATIVE | 81479 |
18. | BCR/ABL1 Major-Minor | 81479 |
Reference:
- Definition of "reasonable and medically necessary": Social Security Act, section 1862(a)(1)(A)
- 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
- National Center for Biotechnology Information website