Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (A58726) - R3 - Effective June 02, 2022

This Billing and Coding Article has been revised and published for notice under contract numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

Effective Date: June 02, 2022

Summary of Article Changes:
Under CPT/HCPCS Codes Group 6: Codes deleted 0151U. Under CPT/HCPCS Codes Group 7: Codes deleted 0097U. This revision is due to the Q2 CPT/HCPCS Code Update and is effective for dates of service on or after 4/1/2022.

Under Article Text revised first and second bullet verbiage to add “or PLA” and deleted third and fourth bullet verbiage. Revised fifth bullet verbiage to add, “and a TA.” Deleted the sixth and seventh bullet verbiage. Added two new bullet verbiages, “Tests that are FDA-approved/cleared and performed in ways consistent with their intended-use labeling directions do not require a Z-code when billed with an appropriate accompanying ICD-10 code. However, the performance of multiple (>1) FDA-approved/cleared molecular Infectious Disease pathogen identification tests on the same date of service (DOS) for the same intended use on the same patient sample is considered as one distinct service. As such, it would require the use of CPT® code 87999. Tests using CPT® code 87999 will require a Z-code and a TA.” And “Add modifier 59 for different species or strains reported by the same code, as allowed by the policy.” Revised Additional Information nineth bullet verbiage to “Places of service (POS) 19, 21, 22, 23 OR” and “(for healthcare POS other than the POS listed in 1 (a).” Under CPT/HCPCS Group 1: Paragraph deleted second sentence. Under CPT/HCPCS Codes Group 1: Codes added 87801. Under CPT/HCPCS Group 2: Paragraph deleted second sentence. Under CPT/HCPCS Group 3: Paragraph deleted second sentence. Under CPT/HCPCS Group 4: Paragraph deleted second sentence. Under CPT/HCPCS Group 5: Paragraph deleted second sentence. Under CPT/HCPCS Group 5: Codes deleted 87623, 87624, and 87625. Under CPT/HCPCS Group 6: Paragraph deleted third sentence. Revised fourth sentence to add “POS 19, 21, 22, 23” and “(for healthcare POS other than those listed in (a).” Under CPT/HCPCS Group 6: Codes added 87801. Under CPT/HCPCS Group 7: Paragraph deleted third sentence. Revised fourth sentence to add “POS 19, 21, 22, 23” and “(for healthcare POS other than those listed in (a).” Under CPT/HCPCS Group 8: Paragraph added verbiage, “Conditionally Non-covered CPT codes: The following CPT codes are NOT covered for a given beneficiary on the same DOS when >1 is billed in combination with another CPT or PLA code from Groups 1-7 for the same intended use. Additionally, the following CPT codes are NOT covered for a given beneficiary on the same DOS when >2 are billed for the same intended use.” Under CPT/HCPCS Group 8: Codes added U0001, U0002, U0003, U0004, U0005, 87471, 87472, 87475, 87476, 87480, 87481, 87482, 87485, 87486, 87487, 87490, 87491, 87492, 87493, 87495, 87496, 87497, 87498, 87501, 87502, 87503, 87510, 87511, 87512, 87516, 87517, 87520, 87521, 87522, 87525, 87526, 87527, 87528, 87529, 87530, 87531, 87532, 87533, 87534, 87535, 87536, 87537, 87538, 87539, 87540, 87541, 87542, 87550, 87551, 87552, 87555, 87556, 87557, 87560, 87561, 87562, 87563, 87580, 87581, 87582, 87590, 87591, 87592, 87623, 87624, 87625, 87634, 87635, 87640, 87641, 87650, 87651, 87652, 87653, 87660, 87661, 87662, 87797, 87798, and 87799. Under CPT/HCPCS Modifiers Group 8: Codes added 59. Under ICD-10 Codes that Support Medical Necessity Group 3: Codes added B60.2. Under ICD-10 Codes that Support Medical Necessity Group 5: Codes added N76.89, N77.1, and N89.8. This revision is effective 06/02/2022.

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 Wed, 25 May 2022 18:53:09 +0000