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February 6, 2015

Molecular Diagnostic Tests (MDTs) Article Updates

Several changes have been made to the coverage articles below, primarily to the correct codes for reporting these services. In most cases, the articles were updated to refer to unlisted CPT code 81479 (unlisted molecular procedure) instead of CPT code 84999 (unlisted chemistry procedure). There are a few tests that have a specific CPT code for dates of service on or after 10/1/2014, instead of the unlisted CPT code.  All articles are housed in the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database:

  • KentuckyExternal Website
  • OhioExternal Website
  • Tip: search by document ID, such as “A53191”

A53191 - MoPath: Afirma™ Assay by Veracyte Update-as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53194 - MoPath: bioTheranostics Cancer TYPE ID® Update- as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53612 - MoPath: ThxID™ BRAF V600/K Test Coding and Billing Guidelines-as of 10/01/2014 use CPT code 81210 instead of CPT code 84999

A53195 - MoPath: cobas® 4800 BRAF V600 Test Billing/Coding Guidelines- as of 10/01/2014 use CPT code 81210 instead of CPT code 84999

A53205 - MoPath: Vectra™ DA Coding and Billing Guidelines- as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53204 - MoPath:therascreen® KRAS PCR Kit Billing/Coding Guidelines-use CPT code 81275 as of 10/01/2014 instead of CPT code 84999

A53197 - MoPath: Corus® CAD Test Coding and Billing Guidelines - as of 10/01/2014 use CPT 81479 instead of CPT code 84999

A53198 - MoPath: HERmark® Assay by Monogram Update - as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53200 - MoPath: Oncotype DX® Breast Cancer Assay Billing and Coding Guidelines –use CPT code 81519 as of 01/01/2015 instead of CPT code 84999

A53201 - MoPath: Oncotype DX® Colon Cancer Coding and Billing Guidelines -as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53202 - MoPath: Progensa® PCA3 Assay Coverage Update - as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53248 - MoPath: ResponseDX Tissue of Origin® Test-use CPT code 81504 as of 01/01/2015 instead of CPT code 84999

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