LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: BCR-ABL

A53531

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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General Information

Source Article ID
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Article ID
A53531
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: BCR-ABL
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
09/19/2024
Revision Ending Date
N/A
Retirement Date
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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Article Guidance

Article Text

Effective for dates of service on and after 4/15/13

Breakpoint testing for BCR-ABL1 is commonly performed as a combination or panel of tests (major, minor and other breakpoints). To report multiple tests assigned a single ID, submit CPT® code 81479. This guideline includes the following CPT® code combinations:

  • 81206 and 81207
  • 81206, 81207, and 81208

CPT® codes 81206, 81207, and 81208 may only be reported when performed as a single test.

To submit a claim for BCR-ABL translocation analysis by NGS, use CPT® 81479 and one (1) UOS with the assigned DEX Z-code.

To report the FDA-approved MRDx BCR-ABL Test use the CPT® code 0040U.

To submit a claim for ABL1 Kinase Domain Mutation Analysis for the detection of acquired imatinib tyrosine kinase inhibitor resistance, use CPT® 81170 and one (1) UOS with the assigned DEX Z-code. See also Group 2 below.

Refer to Billing and Coding: MolDX: Testing of Multiple Genes A57503 for additional information regarding single-gene and panel testing of genes.

Response To Comments

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Coding Information

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Group 1

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ICD-10-CM Codes that Support Medical Necessity

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Group 1 Codes

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Group 2

(4 Codes)
Group 2 Paragraph

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Group 2 Codes
Code Description
C91.00 Acute lymphoblastic leukemia not having achieved remission
C91.02 Acute lymphoblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
09/19/2024 R11

Under Article Text paragraph 5 added “To submit a claim for ABL1 Kinase Domain Mutation Analysis for the detection of acquired imatinib tyrosine kinase inhibitor resistance, use CPT® 81170 and one (1) UOS with the assigned DEX Z-code. See also Group 2 below.” Under CPT/HCPCS Codes Group 2: Paragraph added “The following should be reported for ABL1 Kinase Domain Mutation Analysis for the detection of acquired imatinib tyrosine kinase inhibitor resistance.” Under CPT/HCPCS Codes Group 2: Codes added 81170. Under ICD-10-CM Codes that Support Medical Necessity Group 2: Codes added C92.10, C92.12, C91.00, and C91.02.

02/10/2022 R10

Under Article Text deleted the verbiage, “Laboratories performing BCR-ABL translocation analysis by NGS must obtain a DEX Z-code to differentiate NGS testing from non-NGS methods” and “Reimbursement is based on the number of reported gene(s) in small NGS panels. Tier 1 and/or Tier 2 individual biomarker CPT codes should not be used for a single gene or any combination of genes when testing is performed as part of a NGS or other multiplexing technology panel”. The verbiage, “Refer to Billing and Coding: MolDX: Testing of Multiple Genes A57503 for additional information regarding single-gene and panel testing of genes” was added at the end of the Article Text section.

11/07/2019 R9

This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual. Under Article Title changed title from “MolDX: BCR-ABL Coding and Billing Guidelines” to “Billing and Coding: MolDX: BCR-ABL”. CPT® was inserted throughout the article where applicable.

02/26/2018 R8

Added 0040U to the article. Added 81479, 81206, 81207m 81208, 0040U to HCPCS/CPT Code Group 1. Change is due to the 2019 HCPCS/CPT Annual Update and is effective 1/1/19.

02/26/2018 R7 The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. The notice period for this article begins on 12/14/17 and ends on 02/25/18. Effective 02/26/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
01/29/2018 R6 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this article begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
10/26/2017 R5

Edited article to add DEX Z-Code requirements.

07/20/2017 R4

Added Part A contractor numbers and corrected formatting issue.

10/29/2015 R3 Annual review completed. Replaced reference of Palmetto to carrier
10/29/2015 R2 Annual review completed, no changes needed.
10/01/2015 R1 Added Annual Review Date.
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Public Versions
Updated On Effective Dates Status
09/09/2024 09/19/2024 - N/A Currently in Effect You are here
02/02/2022 02/10/2022 - 09/18/2024 Superseded View
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