LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: BCR-ABL

A55600

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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
A55600
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: BCR-ABL
Article Type
Billing and Coding
Original Effective Date
12/01/2017
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 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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CPT/HCPCS Modifiers

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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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.

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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 R5

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.

Updated Article Text to include Effective for dates of service on and after 4/15/13. Noridian has modified certain language in the articles (LCA) to mirror the language used presently by the MolDX team at Palmetto GBA as part of an annual review. Revision history dates and language may not exactly match the MolDX PGBA revision history. However, these revisions do not change coverage or guidance.

02/10/2022 R4

Updated to indicate this article is an LCD Reference Article.

02/10/2022 R3

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: 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: 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.

Noridian has modified certain language in this article to mirror the language used presently by the MolDX team at PalmettoGBA as part of an annual review. Revision history dates and language may not exactly match the MolDX PGBA revision history. However, these revisions do not change coverage or guidance.

11/01/2019 R2

Added 0040U effective 1/1/19, per the 2019 CPT/HCPCS Annual Update and consistency with the MolDX Contrctor and converted article to Billing and Coding Article type.

12/01/2017 R1

Article is revised to provide updated billing instructions and reimbursement 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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Public Versions
Updated On Effective Dates Status
09/09/2024 09/19/2024 - N/A Currently in Effect You are here
11/22/2023 02/10/2022 - 09/18/2024 Superseded View
02/10/2022 02/10/2022 - N/A Superseded View
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