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Molecular Pathology CPT codes

Apurva Posted Sun 16th of February, 2020 23:29:36 PM
As per CPT manual the CPT for the genes HOXB13, CHEK2, RAD51D is 84179. Need confirmation if CPT 81403 can be billed for HOXB13 - If mutation scanning is 2-5 exons and CPT 81405 for CHEK2, RAD51D If mutation scanning is 11-25 exons
SuperCoder Answered Mon 17th of February, 2020 07:37:27 AM

Thank you for the Question!

A full description of the testing performed is required in the narrative/remarks when using these codes.

Use the appropriate molecular pathology procedure level code that includes the specific analyte listed after the code descriptor. If the analyte tested is not listed under one of the Tier 2 codes or is not represented by a Tier 1 code, use the unlisted molecular pathology procedure code, 81479.

CPT code 81403 states The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 4 molecular pathology code. CPT code 81405 The lab analyst performs the technical lab tests to complete one of the specific genetic analyses listed in this Tier 2, Level 6 molecular pathology code. These code selections are applicable when the test performed for specific gene matches with the Tier 1 or 2 gene list. 

https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52986

 

Hope that helps!

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