Skip to Main Content

Print | Bookmark | Font Size: + |

April 5, 2013

Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing Coding and Billing Guidelines

Effective for dates of service on and after January 1, 2013. 

ARVD/C, characterized by fatty replacement of heart cells predominantly in the right ventricle of the heart, is most often inherited as an autosomal dominant disease that may be associated with testing in at least seven genes (RYR2, TMEM43, DSP, PKP2, DSG2, DSC2 and JUP). Genetic testing may be performed in panels of 5-7 of these genes and disease-causing mutation is expected to be identified in 42-55% of cases. Testing would be performed to confirm an established diagnosis or on individuals already diagnosed with ARVD/C to identify family members at risk. CGS Administrators has determined that testing for ARVD/C is a statutorily excluded test.

The following ARVD/C tests have been identified as non-covered:

Test

ARVC Sequencing Panel

To receive an ARVD/C test denial, please submit the following claim information:

  • CPT code 81479 (effective 01/01/2013)
  • 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
  • Enter the appropriate identifier adjacent to each code in the stack in the comment/narrative field for the following claim field/types:
    • Loop 2400, NTE02, or SV101-7 for the 5010A1 837P
    • Box 19 for paper claim

Reference: Sec. 1862 (1)(A) Statutory Exclusion covers diagnostic testing "except for items and services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member,…"

spacer

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