April 5, 2013
Know Error® DNA Specimen Provenance Assay: Coding and Claim Submission Guidelines
The know error® DNA Specimen Provenance Assay is a forensic assay to confirm that a surgical specimen belongs to the patient evaluated for treatment. Although CGS agrees the health care community should define and follow strict procedures regarding patient and patient specimen identification and handling, tests performed to measure the quality of a process do not provide information to diagnose or treat a patient illness or injury and are therefore not a Medicare benefit. Accordingly, the know error® DNA Specimen Provenance Assay is a statutorily excluded test.
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 the know error® test must include:
- CPT code 84999 – unlisted chemistry procedure
- HCPCS modifier GY (statutorily non-covered service)
- The appropriate ICD-9-CM code(s)
- Enter 'DNA specimen provenance' in the comment/narrative field:
- Electronic claims: Loop 2400, NTE02, or SV101-7 field
- Paper claims: Block 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


