Billing and Coding: MolDX: BCR-ABL (A55600)- R5 - Effective September 19, 2024

Date Posted: September 19, 2024

This Local Coverage Article (LCA) has been revised under contractor numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

Effective Date: September 19, 2024

Summary of Changes:

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.

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