Molecular Pathology (MoPath): Reimbursement for Unlisted Molecular Pathology CPT Code 81479
As instructed by CMS, CGS has determined a gap fill allowance for the 2013 unlisted molecular pathology CPT code (81479), depending on the test being submitted. This is not an all-inclusive list and will be updated as new test(s) are reviewed for coverage.
Claim Submission
All services to produce the assay result were evaluated and included in the listed fee. CGS has included the coverage determination established during the review of available literature. We will continue to update this fee schedule as additional MoPath services are evaluated.
- Please include the name of the test:
- Electronic Claims: Loop 2400, NTE02, or SV101-7 field
- Paper Claims: Block 19
- If the name of the test is not included on the claim and HCPCS modifier GY is not submitted, the claim will be rejected as unprocessable (remark code MA130). Rejected claims must be corrected and resubmitted as new claims.
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
Note: In covered column, Y=covered and N=non-covered
CPT Code | Descriptor | CGS-LDT | Covered | Comment |
---|---|---|---|---|
81479 | VIM (Vimentin) | $0 | N | Article published |
81479 | NAT-2 (N-acetyltransferase 2 (arylamine N-acetyltransferase) | $0 | N | Article published |
81479 | SULT4A1 (sulfotransferase family 4A, member 1) | $0 | N | Article published |
81479 | SLC01B1 (Solute Carrier organic Anion Transporter family, member 1B1) | $0 | N | Article published |
81479 | CertNDx (this includes TWIST-1, NID-2, MMP-2) | $0 | N | Article published |
81479 | ARVC Sequencing Panel (Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy) | $0 | N | Article published |
81479 | L1CAM gene sequencing | $0 | N | Article published |
81479 | Comprehensive Mitochondrial Nuclear Gene Panel or Mitochondrial Genome Sequence | $0 | N | Article published |
81479 | PAX6 Gene Sequencing (WAGR syndrome) | $0 | N | Article published |
81479 | HAX1 Gene Sequencing or ELA2 gene analysis (Kostmann disease and congenital neutropenia) | $0 | N | Article published |
81479 | PreDx Diabetes Risk Score (DRS) | $0 | N | Article published |
81479 | Pervenio Lung RS Assay | $0 | N | Article published |
81479 | Know Error DNA Specimen Provenance Assay | $0 | N | Article published |
81479 | BluePrint | $0 | N | Article published |
81479 | ADRA2A (adrenoceptor alpha 2A) | $0 | N | Article published |
81479 | SLC6A4 (solute carrier family 6 (neurotransmitter transporter, serotonin), member 4) | $0 | N | Article published |
81479 | HTR2A (5-hydroxytryptamine (serotonin) receptor 2A, G protein-coupled) | $0 | N | Article published |
81479 | COMT (catechol-O-methyltransferase) | $0 | N | Article published |
81479 | CYP1A2 (cytochrome P450, family 1, subfamily A, polypeptide 2) | $0 | N | Article published |
81479 | OPRM1 (opioid receptor, mu 1) | $0 | N | Article published |
81479 | CHD7 Gene Sequencing | $0 | N | Article published |
81479 | HTTLPR Gene Testing – Serotonin Transporter genotyping | $0 | N | Article published |
Revised: 08.12.13