RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing

A55142

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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
N/A
Article ID
A55142
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing
Article Type
Billing and Coding
Original Effective Date
02/16/2017
Revision Effective Date
11/30/2023
Revision Ending Date
06/27/2024
Retirement Date
06/27/2024

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1862(a)(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." 

Article Guidance

Article Text

Effective for dates of service on and after 2/7/2013.

Asparoacyclase 2 Deficiency (ASPA) Testing, also known as Canavan Disease, is an autosomal recessive degenerative disorder that causes progressive nerve damage to nerve cells in the brain. Genetic testing identifies parents that may be at risk for conceiving a child with the disease and offspring suspected to have or diagnosed with the disease. Therefore, the MolDX Team has determined that testing for the ASPA is not a Medicare benefit and is a statutorily excluded test. MolDX will also deny panels that include ASPA testing.

To receive an ASPA service denial, please submit the following claim information:

  • Select one of the following CPT codes for the performed service:
    • 81200 - ASPA, common variant
    • 81412 - Ashkenazi Jewish associated disorders
    • 81443 - Genetic testing for severe inherited conditions
    • 81479 - Unlisted molecular pathology procedures 
  • An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
    • For a voluntary issued ABN, append with GX modifier
    • To indicate a statutorily excluded service, append with a GY modifier 
  • Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information. 
  • Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:
    • Loop 2400 or SV101-7 for the 5010A1 837P
    • Box 19 for paper claim 
  • Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
    • Line SV202-7 for 837I electronic claim
    • Block 80 for the UB04 claim form 

Response To Comments

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Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

(2 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
GX NOTICE OF LIABILITY ISSUED, VOLUNTARY UNDER PAYER POLICY
GY ITEM OR SERVICE STATUTORILY EXCLUDED, DOES NOT MEET THE DEFINITION OF ANY MEDICARE BENEFIT OR, FOR NON-MEDICARE INSURERS, IS NOT A CONTRACT BENEFIT
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ICD-10-CM Codes that Support Medical Necessity

Group 1

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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

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ICD-10-PCS Codes

Group 1

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Group 1 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
06/27/2024 R7

Posted 06/27/2024: This article is being retired because it is not supported by a Local Coverage Determination (LCD) and does not comply with current 21st Century Cures requirements.

11/30/2023 R6

Posted 11/30/2023: Biannual review completed with no change in coverage. No changes were made to the article.

11/25/2021 R5

11/25/2021-Review completed 10/12/2021; no changes made.

11/01/2019 R4

Content moved to the new template. Under Article Text deleted the statement “Select the appropriate diagnosis for the patient” & Title XVIII of the Social Security Act, §1862(a)(1)(A) has been added to the CMS National Coverage Policy section and removed from the Article Text section. Moved CPT codes 81412 & 81443 from CPT/HCPCS Codes Group 1: Codes to CPT/HCPCS Codes Group 2: Codes & added verbiage “CPT codes that are also referenced in other articles.” Added GX & GY modifiers to the modifier table. Review completed 11/19/2019.

01/01/2019 R3

02/01/2019-Code update: Added 81443.

06/01/2018 R2

 

06/01/2018-Annual review completed 05/02/2018.

07/01/2017 R1

07/01/2017- Annual review completed 06/08/2017; Updated billing instructions, added Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information & added Part A billing instructions and updated Part B instructions.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L36807 - MolDX: Molecular Diagnostic Tests (MDT)
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
06/27/2024 11/30/2023 - 06/27/2024 Retired You are here
11/20/2023 11/30/2023 - N/A Superseded View
11/16/2021 11/25/2021 - 11/29/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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