LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268)

A54830

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Source Article ID
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Article ID
A54830
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268)
Article Type
Billing and Coding
Original Effective Date
01/07/2016
Revision Effective Date
04/04/2024
Revision Ending Date
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Retirement Date
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Article Text

Please note that CPT® codes 81265 and 81266 describe services performed for recipient/donor testing and twin zygosity. Laboratories are encouraged to register tests based on the use of the test. Through the MolDX identification process, tests registered for recipient/donor testing will be considered for payment and tests for twin zygosity will be denied as a statutorily excluded service. The following instructions outline the correct reporting of recipient/donor testing for transplant services.

Chimerism analysis to identify appropriate donors and monitor engraftment success or disease reoccurrence is a covered Medicare service.

  • Code 81265 should be reported with one unit of service (UOS). Except in rare cases, this service would only be performed once per lifetime.

  • Code 81266, when used in bone marrow transplants to report an additional double-cord blood sample, is a covered service.

  • Code 81267 should be used post transplantation to confirm successful engraftment or disease reoccurrence. Although the original donor specimen may be referenced, an additional 81265 should NOT be submitted in addition to the 81267 service. For labs that hold the pre-transplant specimen (81265 and/or 81266) until after the transplant occurs, use 81267 plus 81265 and 81266 if necessary.



Note: Code 81267 should be reported for the findings of the pre and post-transplant comparison.

  • Code 81268 should be used to report chimerism using a buccal or other germline tissue specimen from the recipient post-transplantation. For labs that hold the pre-transplant specimen (81265 and/or 81266) until after the transplant occurs, use 81267 plus 81265 and 81266 if necessary.



MolDX would not expect to see a claim for 81265 pre-transplant and an additional 81265 and 81267 post-transplant or a claim for 81265 pre-transplant and an additional claim for 81268.

EXCEPTIONS: Although the initial chimerism testing, code 81265, for engraftment is usually limited to once in a lifetime, MolDX recognizes special circumstances may require an additional service and will consider approval on a case-by-case basis through the appeal process.

NOTE: When entering the DEX Z-Code® on the SV101-7 documentation field for Part B claims please do not add additional characters and/or information on the line.

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Revision History Information

Revision History Date Revision History Number Revision History Explanation
04/04/2024 R4

Revision Effective: 04/04/2024

Revision Explanation: Under Article Title revised to read Billing and Coding: MolDX: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268). Under CMS National Coverage Policy revised 3rd section heading. Under Article Text revised 7th and 10th bullets to remove “DEX Z-Code™” and replaced with “DEX Z-Code®”. Added “NOTE: When entering the DEX Z-Code® on the SV101-7 documentation field for Part B claims please do not add additional characters and/or information on the line”. Formatting was corrected throughout the article. This revision is effective 4/4/2024.

Under CPT/HCPCS Group 1: Codes added 81479. This is effective 3/5/2024.

11/16/2023 R3

Revision Effective: 11/16/2023

Revision Explanation: Updated LCD Reference Article section.

12/12/2019 R2

Revision Effective date: 12/12/2019
Revision Explanation: Under Article Title changed title from Billing and Coding: MolDX: Short Tandem Repeat (STR) Markers and Chimerism (codes 81265-81268) Coding and Billing Guidelines to Billing and Coding: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268). CPT® was inserted throughout the article where appropriate. Added Bill Type code 023X which was inadvertently left off.

10/03/2019 R1

Revision Effective date: 10/03/2019
Revision Explanation: Converted article into new billing and coding article format.

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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
L36021 - MolDX: Molecular Diagnostic Tests (MDT)
Related National Coverage Documents
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Updated On Effective Dates Status
04/05/2024 04/04/2024 - N/A Currently in Effect You are here
11/07/2023 11/16/2023 - 04/03/2024 Superseded View
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