Skip to Main Content

Print | Bookmark | Font Size: + | –

April 11, 2013

BLM Gene Analysis: Coding and Claim Submission Guidelines

The clinical diagnosis of Bloom (BLM syndrome (BSyn)), characterized by severe pre- and postnatal growth deficiency and highly characteristic sparseness of subcutaneous fat tissue in infants and children, is confirmed through cytogenetic testing. Molecular genetic testing identifies BLM gene mutation carriers at risk for conceiving offspring with the disease. Therefore, BLM genetic testing is not a Medicare benefit and is a statutorily excluded service. In addition to single gene testing, CGS Administrators will also deny panels of tests that include the BLM gene as statutorily excluded services.

The following tests have been identified as non-covered:

Test

Bloom (BLM) 2281del6/ins7 Mutation

Bloom (BLM) 2281del6/ins7 Mutation, Fetal

BLOOM SYNDROME DNA MUTAT

Bloom Syndrome, Mutation Analysis, 2281del6/ins7

Ashkenazi Jewish FlexPanel

Ashkenazi Jewish FlexPanel

Ashkenazi Jewish Diseases (BLM, ASPA, IKBKAP, FANCC, GBA, MCOLN1, SMPD1, HEXA)


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 BLM gene analysis must include:

  • For dates of service prior to January 1, 2013: use the appropriate CPT code stack for the test
  • For dates of service on or after January 1, 2013: CPT code 81209
  • HCPCS modifier GY (statutorily non-covered service)
  • The appropriate ICD-9-CM code(s)
  • The name of the test:
    • Electronic claims: Loop 2400, NTE02, or SV101-7 field
    • Paper claims: Box 19

Reference:

spacer

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