LCD Reference Article Billing and Coding Article

Billing and Coding: MolDx: BCR-ABL

A55233

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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
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Article ID
A55233
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDx: BCR-ABL
Article Type
Billing and Coding
Original Effective Date
02/16/2017
Revision Effective Date
09/19/2024
Revision Ending Date
N/A
Retirement Date
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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 A57880 for additional information regarding single-gene and panel testing of genes.

  • 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

Code Description

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

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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

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
09/19/2024 R9

Posted 09/26/2024: 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.

12/28/2023 R8

Posted 12/28/2023: Biannual review completed with no change in coverage. No changes were made to the article.

02/24/2022 R7

Posted 02/24/2022-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 A57880 for additional information regarding single-gene and panel testing of genes” was added at the end of the Article Text section.

10/29/2020 R6

10/29/2020 Review completed 09/15/2020.

11/01/2019 R5

Content has been moved to the new template.

01/01/2019 R4

02/01/2019-Code update: added code 0040U.

11/01/2018 R3

11/01/2018-Annual review completed 10/10/2018. Updated the “Related Local Coverage Document(s)” section below: Added a link to our L36815 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease LCD & removed the link to our L36807 MolDX: Molecular Diagnostic Tests (MDT) LCD.

12/01/2017 R2

 

12/01/2017 Added major, minor and other breakpoints & labs performing BCR-ABL translocation analysis by NGS must obtain a DEX Z-code to differentiate NGS testing from non-NGS methods & reimbursement is based on the number of reported gene(s) in small NGS panels. Updated billing and claim submission information. Annual review completed 11/03/2017.

 

07/01/2017 R1

 


07/01/2017-Annual review completed 06/09/2017; Added Part A & B  billing instructions & Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information.


 

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Updated On Effective Dates Status
09/17/2024 09/19/2024 - N/A Currently in Effect You are here
12/20/2023 12/28/2023 - 09/18/2024 Superseded View
02/16/2022 02/24/2022 - 12/27/2023 Superseded View
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