Skip to Main Content

Print | Bookmark | Email | Font Size: + |

July 26, 2013Revised: 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:

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved