Billing and Coding: MolDX: BRCA1 and BRCA2 Genetic Testing - R4 - Effective October 1, 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: October 1, 2021
Summary of Article Changes:

Effective 10/01/2021: Under ICD-10 Codes that Support Medical Necessity Group 1: Code added C56.3

Effective 04/29/2021: Under CMS National Coverage Policy moved regulation CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80 to the related LCD.

Under CPT/HCPCS Codes Group 3: Codes deleted 81445 and 81455. CPT® code 81162 was moved from CPT/HCPCS Codes Group 3: Codes to CPT/HCPCS Codes Group 1: Codes.

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted C25.9, C50.019, C50.029, C50.119, C50.129, C50.219, C50.229, C50.319, C50.329, C50.419, C50.429, C50.519, C50.529, C50.619, C50.629, C50.819, C50.829, C50.911, C50.912, C50.919, C50.921, C50.922, C50.929, C56.9, and C57.00. 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 17:49:06 +0000