Billing and Coding: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs) - R4 - Effective November 08, 2021

This Billing and Coding Article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI), and 01312 (NV).

Effective Date: November 08, 2021
Summary of Article Changes:

Effective 11/08/2021: Under ICD-10 Codes that Support Medical Necessity Group 2: Codes added A41.9. R65.20, and R65.21.

Effective 10/21/2021: Under Article Text added “This contractor expects that critically ill patients will be tested and managed in the appropriate inpatient facility. As such, for critically ill patients, only Part A claims should be submitted.” Under CPT/HCPCS Codes Group 2: Paragraph revised to “This code is covered in beneficiaries with immunodeficiency AND/OR critical illness.” Under ICD-10 Codes that Support Medical Necessity Group 2: Paragraph revised to “For immunosuppressed patients, to bill for 87507 or 0097U, an ICD-10 diagnosis code from Group 2 must be on the claim in addition to an ICD-10 diagnosis code from Group 1.” Under ICD-10 Codes that Support Medical Necessity Group 2: Codes deleted A04.9, A09, K56.0, R10.0, and R19.7.

Effective 10/01/2021: Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added M31.19. Under ICD-10 Codes that Support Medical Necessity Group 2: Codes added D89.44, T80.82XS, Z92.850, Z92.858, and Z92.86. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/2021.

Effective 08/05/2021: Under CMS National Coverage Policy removed regulation CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15 §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests. Added regulation CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 A/B MAC (B) Contacts with Independent Clinical Laboratories. Under CPT/HCPCS Codes Group 1: Codes moved 0097U from Group 1 codes to Group 2 codes. Under ICD-10 Codes that Support Medical Necessity Group 1: Paragraph deleted 0097U. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added A00.0, A00.1, A00.9, A01.09, A01.1, A01.2, A01.3, A02.8, A05.4, A05.5, A06.0, A06.1, A06.2, A07.1, A07.2, A07.4, A08.0, A08.11, A08.2, A08.32, A32.11, A32.12, A32.7, K56.0, and R10.0. Deleted A02.9, B20, D80.0, D80.1, D80.2, D80.3, D80.4, D80.5, D80.6, D80.7, D80.8, D80.9, D81.0, D81.1, D81.2, D81.30, D81.31, D81.32, D81.39, D81.4, D81.5, D81.6, D81.7, D81.810, D81.818, D81.819, D81.89, D81.9, D82.0, D82.1, D82.2, D82.3, D82.4, D82.8, D82.9, D83.0, D83.1, D83.2, D83.8, D83.9, D84.0, D84.1, D84.89, D84.9, D89.0, D89.1, D89.2, D89.3, D89.40, D89.41, D89.42, D89.43, D89.49, D89.810, D89.811, D89.812, D89.813, D89.82, D89.89, D89.9, Y92.239, Z94.0, Z94.1, Z94.2, Z94.3, Z94.4, Z94.5, Z94.6, Z94.81, Z94.82, Z94.83, and Z94.84. Under ICD-10 Codes that Support Medical Necessity Group 2: Paragraph revised to “To bill for 87507 or 0097U, an ICD-10 diagnosis code from Group 2 must be on the claim in addition to an ICD-10 diagnosis code from Group 1”. Under ICD-10 Codes that Support Medical Necessity Group 2: Codes added A04.9, A09, D61.09, D61.1, D61.2, D61.3, D61.810, D61.811, D61.818, D61.82, D61.89, D61.9, D64.81, D64.89, D70.0, D70.1, D70.2, D70.3, D70.4, D70.9, D84.821, D84.822, K56.0, R10.0, and R19.7. Deleted D80.7, D81.819, D82.9, D84.9, D89.2, D89.40, D89.9, and Y92.239. Formatting, punctuation, and typographical errors were corrected throughout the article.

Visit the Molecular Diagnostic Services (MolDX) webpage to access the locally hosted MolDX Medicare Coverage Article from the “Covered Tests” or the “Excluded Tests” webpage.

To view the complete listing of locally hosted coverage articles and/or access the Active, Future, or Retired articles available in the CMS MCD, visit the Medicare Coverage Articles webpage.

            Last Updated Fri, 05 Nov 2021 17:56:49 +0000