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April 5, 2013

Cytogenomic Constitutional Microarray Analysis Coding and Billing Guidelines

CGS Administrators has determined that cytogenomic constitutional microarray analysis is not a Medicare covered service. Screening in the absence of signs and symptoms of an illness or injury is not defined as a Medicare benefit. Therefore, CGS will deny cytogenomic constitutional microarray analysis as a statutorily excluded service.   

The following cytogenomic constitutional microarray analysis services have been identified as non-covered:

Test

Cytogenomic SNP Microarray

Cytogenomic SNP Microarray Buccal Swab

Genomic Alerations, Prenatal, Clarisure Oligo-SNP Array

Genomic Alterations, Postnatal, ClariSure(R) Oligo-SNP (Follow-up)

Signature PrenatalChip®OS + SNP - Cultured Amnio/CVS

Signature PrenatalChip®OS + SNP - Direct Amnio/CVS

Signature PrenatalChip®TE + SNP - Culture Amnio/CVS

Signature PrenatalChip®TE + SNP - Direct Products of Conception or Tissue

Signature PrenatalChip®TE +SNP - Prenatal blood

Signature PrenatalChip®TES + SNP - DNA

SignatureChipOS® + SNP - DNA

SignatureChipOS® + SNP - Peripheral Blood

SNP Array CGH

To receive a cytogenomic constitutional microarray analysis service denial, please submit the following claim information:

  • Appropriate CPT code(s) for the test for DOS prior to January 1, 2013
  • Appropriate CPT code 81228 or 81229
  • Append with GA HCPCS modifier to indicate a valid Advance Beneficiary Notice (ABN) is on file for the service
  • Select the appropriate diagnosis for the patient

Reference:

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