Billing and Coding: MolDX: Genetic Testing for Lynch Syndrome - R5

This coverage article has been revised and published for notice under contract numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Dates: 01/01/2020 and 07/31/2020
Summary of Article Changes:
Addition of coding to Group 1, effective 07/31/2020:

  • 81432, hereditary breast cancer-related disorders (e.g., hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least 10 genes, always including BRCA1, BRCA2, CDH1, MLH1, MSH2, MSH6, PALB2, PTEN, STK11, AND TP53
  • 81433, hereditary breast cancer-related disorders (e.g., hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, AND STK11

Addition of coding to Group 2, effective 01/01/2020:

  • 0157U, APC (APC regulator of WNT signaling pathway) (e.g., familial adenomatosis polyposis [FAP]) MRNA sequence analysis (list separately in addition to code for primary procedure)
  • 0158U, MLH1 (MUTL homolog 1) (e.g., hereditary non-polyposis colorectal cancer, lynch syndrome) MRNA sequence analysis (list separately in addition to code for primary procedure)
  • 0159U, MSH2 (MUTS homolog 2) (e.g., hereditary colon cancer, lynch syndrome) MRNA sequence analysis (list separately in addition to code for primary procedure)
  • 0160U, MSH6 (MUTS homolog 6) (e.g., hereditary colon cancer, lynch syndrome) MRNA sequence analysis (list separately in addition to code for primary procedure)
  • 0161U, PMS2 (PMS1 homolog 2, mismatch repair system component) (e.g., hereditary nonpolyposis colorectal cancer, lynch syndrome) MRNA sequence analysis (list separately in addition to code for primary procedure)
  • 0162U, hereditary colon cancer (lynch syndrome), targeted MRNA sequence analysis panel (MLH1, MSH2, MSH6, PMS2) (list separately in addition to code for primary procedure)

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            Last Updated Thu, 09 Jul 2020 17:41:30 +0000