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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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April 5, 2013

L1CAM Gene Sequencing: Coding and Claim Submission Guidelines

L1 syndrome refers to multiple disorders, including X-linked hydrocephalus with aqueduct of Sylvius (HSAS) stenosis, MASA syndrome (Mental retardation, Aphasia, Spastic paraplegia, Adducted thumbs), SPG1 (X-linked complicated hereditary spastic paraplegia type 1), and X-linked complicated corpus callosum agenesis. Because there are many potential underlying causes for congenital hydrocephalus, including syndromic and nonsyndromic cases, recurrence risk and implications for family members is based upon underlying etiology. Genetic testing of the L1CAM gene is performed to confirm a clinical diagnosis and provide recurrence risk. Therefore, CGS has determined L1CAM gene sequencing is a statutorily excluded test.

The following L1CAM gene sequencing test has been identified as non-covered:

Test
L1CAM Gene Sequencing and Deletion/Duplication

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 L1CAM gene sequencing tests must include:

Appropriate CPT code stack for the test prior and up to December 31, 2012
For dates of service on or after January 1, 2013: CPT code 81479
HCPCS modifier GY (statutorily non-covered service)
The appropriate ICD-9-CM code(s)

Enter L1CAM 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

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

L1CAM Gene Sequencing: Coding and Claim Submission Guidelines

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