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Clinical Lab Gap Filled Codes

View the Noridian Clinical Lab Gap Filled Codes.

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81161 DMD Dup/Delet Analysis   N   N   N
81200 Canavan Dz   N   N   N
81201 APC, full gene analysis $749.92 Y   $749.92 $749.92 Y
81202 APC, known fam var $93.94 Y   $93.94 $93.94 Y
81203 APC dup/del var $570.05 Y   $570.05 $570.05 Y
81205 Maple Syrup Testing   N   N   N
81206 BCR/ABL1, trans location major break $108.37 Y $225.38 Y $225.38 Y
81207 BCR/ABL1, trans location minor break $90.31 Y $199.08 Y $199.08 Y
81208 BCR/ABL1, trans location other break $150.17 Y $221.09 Y $221.09 Y
81209 Bloom Syndrome   N   N   N
81210 BRAF Gene $97.45 Y $180.60 Y $180.60 Y
81211 BRCA1/2 full seq $2,795.09 Y $2,795.09 Y $2,795.09 Y
81212 BRCA1/2, variants $178.04 Y $178.04 Y $178.04 Y
81213 BRCA1/2 uncommon del/dup $587.12 Y $587.12 Y $587.12 Y
81214 BRCA1 alone, full seq $1,449.01 Y $1,449.01 Y $1,449.01 Y
81215 BRCA1 alone, known fam var $93.94 Y $93.94 Y $93.94 Y
81216 BRCA2 alone, full seq   N   N   N
81217 BRCA2 alone, known fam var $93.94 Y $93.94 Y $93.94 Y
81220 CF testing   N   N   N
81221 CF testing   N   N   N
81222 CF testing   N   N   N
81223 CF testing   N   N   N
81224 CF testing   N   N   N
81225 Cyp2c19 full Seq $319.12 Y $294.00 Y $294.00 Y
81226 Cyp2d6 $426.43 Y $455.00 Y $455.00 Y
81227 Cyp2c9 $169.50 Y $176.40 Y $176.40 Y
81228 Cytogen microarray copy nmbr   N   N   N
81229 Cytogen microarray copy no&snp   N   N   N
81235 EGFR genr analysis, comm variants $225.00 Y $332.50 Y $332.50 Y
81240 F2 Gene $41.41 Y $67.64 Y $67.64 Y
81241 F5 Gene $78.39 Y $84.00 Y $84.00 Y
81242 Fanconi Gene   N   N   N
81243 Fragile X Gene   N   N   N
81244 Fragile X Gene   N   N   N
81245 Flt3 gene $112.00 Y $167.17 Y $167.17 Y
81246 Flt3 gene         $82.96 Y
81250 Glycogen Storage Gene   N   N   N
81251 Glycogen Storage Gene   N   N   N
81252 GJB2 common var   N   N   N
81253 GJB2, known fam variants   N   N   N
81254 GJB6 common var   N   N   N
81255 Tay Sach Gene   N   N   N
81256 Hfe gene $70.20 Y $89.84 Y $89.84 Y
81257 Hba1/hba2 gene   N   N   N
81260 familial dysautonomia gene   N   N   N
81261 Igh gene rearrange amp meth $148.12 Y $272.15 Y $272.15 Y
81262 Igh gene rearrange dir probe $51.12 Y $51.12 Y $51.12 Y
81263 Igh gene regional mutation $259.93 Y $404.83 Y $404.83 Y
81264 Igk gene rearrange bn clonal pop $111.98 Y $205.26 Y $205.26 Y
81265 DSPA/STR Seq   N       N
81266 DSPA/STR Seq   N       Y
81267 Chimerism anal no cell sel $149.72 Y $285.17 Y $285.17 Y
81268 Chimerism anal w/ cell select $149.72 Y $358.47 Y $358.47 Y
81270 JAK2 gene analysis $82.88 Y $126.00 Y $126.00 Y
81275 KRAS gene analysis $246.40 Y $179.20 Y $179.20 Y
81280 Long QT Synd gene   N   N   N
81281 Long QT Synd gene   N   N   N
81282 Long QT Synd gene   N   N   N
81287 MGMT         $83.01 Y
81288 MLH promoter methylation         $159.48 Y
81290 Mucolipidosis   N   N   N
81291 Mthfr gene $92.92 Y $60.00 Y $60.00 Y
81292 MLH1 gene analysis, full seq $803.28 Y $651.12 Y $651.12 Y
81293 MLH1 gene analysis, known fam var $93.94 Y $261.02 Y $261.02 Y
81294 MLH1 gene analysis, del/dup $491.96 Y $192.12 Y $192.12 Y
81295 MSH2 gene anal, Full seq $787.22 Y $152.86 Y $152.86 Y
81296 MSH2 gene anal, known fam var $93.94 Y $130.51 Y $130.51 Y
81297 MSH2 gene anal, del/dup $542.77 Y $152.86 Y $152.86 Y
81298 MSH6 gene anal, full seq $617.61 Y $290.01 Y $290.01 Y
81299 MSH6 gene anal, known fam var $93.94 Y $162.46 Y $162.46 Y
81300 MSH6 gene anal, dup/del $505.15 Y $162.90 Y $162.90 Y
81301 Microsatellite instability $320.84 Y $398.03 Y $398.03 Y
81302 Rett Syndrome gene   N   N   N
81303 Rett Syndrome gene   N   N   N
81304 Rett Syndrome gene   N   N   N
81310 Npm1 gene $58.84 Y $249.01 Y $249.01 Y
81313 PCA3/KLK3           N
81315 PML/RARalpha qual or quant $117.54 Y $284.97 Y $284.97 Y
81316 PML/RARalpha single brkpoint NO DATA Y $434.65 Y $434.65 Y
81317 PMS2 full sequence $642.58 Y $787.19 Y $787.19 Y
81318 PMS2, gene anal, known fam var $93.94 Y $186.01 Y $186.01 Y
81319 PMS2 gene anal, dup/del $462.42 Y $223.34 Y $223.34 Y
81321 PTEN gene anal full seq $605.24 Y $605.24 Y $605.24 Y
81322 PTEN, known familial var $58.84 Y $60.00 Y $60.00 Y
81323 PTEN, dup/del $88.26 Y $88.26 Y $88.26 Y
81324 PMP22 gene anal, dup/del   N   N   N
81325 PMP22, full seq   N       N
81326 PMP22, known familial variants $93.94 Y   N   N
81330 Niemann Pick gene   N   N   N
81331 Prader Willis gene   N   N   N
81332 Serpina1 gene $70.20 Y $60.00 Y $60.00 Y
81340 Trb@ gene rearrange amp $148.12 Y $287.17 Y $287.17 Y
81341 Trb@ gene rearrange diporbe $45.44 Y $68.16 Y $68.16 Y
81342 Trg gene rearrangement anal $148.12 Y $276.98 Y $276.98 Y
81350 UGT1A1 irinotecan gene   N   N   N
81355 Vkorc1 gene $83.19 Y   N   N
81370 HLA I Typing, antigen equiv $552.75 Y $552.75 Y $552.75 Y
81371 81370 verification $330.84 Y $330.84 Y $330.84 Y
81372 HLA Class I typing, low res, complete $303.64 Y $303.64 Y $303.64 Y
81373 HLA Class I typing, low res, one locus $153.08 Y $153.08 Y $153.08 Y
81374 HLA Class I typing, low res, one antigen $100.00 Y $100.00 Y $100.00 Y
81375 HLA Class II typing, low res $303.43 Y $303.43 Y $303.43 Y
81376 HLA Class II typing, low res, one locus $168.00 Y $168.00 Y $168.00 Y
81377 HLA Class II typing, low res, one antigen equiv $126.20 Y $126.20 Y $126.20 Y
81378 HLA Class I and II high res, alleles $475.00 Y $475.00 Y $475.00 Y
81379 HLA Class I and II high res, complete $461.00 Y $461.00 Y $461.00 Y
81380 HLA Class I and II high res, one locus $243.64 Y $243.64 Y $243.64 Y
81381 HLA Class I and II high res, one allele or allele grp $130.00 Y $130.00 Y $130.00 Y
81382 HLA Class II high res, one locus $170.00 Y $170.00 Y $170.00 Y
81383 HLA Class II high res, one allele or allele grp $150.00 Y $150.00 Y $150.00 Y
81410 Aortic dysf panel, seq           N
81411 Aortic dysf panel, dup/del           N
81415 Exome, seq proband           N
81416 Exome, seq, parents, sibs           N
81417 Exome, reeval           N
81420 Fetal aneuploidy           N
81425 Genome, seq, proband           N
81426 Genome, seq, parents, sibs           N
81427 Genome, reeval           N
81430 Hearing loss panel, seq 60 genes           N
81431 Hearing loss panel, dup/del           N
81435 Hered. colon Ca panel, seq           N
81436 Hered. colon Ca, dup/del           N
81440 Mito, seq           N
81445 Targ seq, solid organ, DNA only 5-50           Y
81450 Targ seq immuno-hemat, DNA/RNA 5-50           Y
81455 Targ, solid/hemato, DNA/RNA, >51           N
81460 Whole mito genome, seq           N
81465 Whole mito genome, dup/del           N
81470 X-linked intel disability, seq           N
81471 X-linked intel disabil, dup/del           N

81400 Mole Path Level 1

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81400 A282V variant   N   N   N
81400 ABCC8   N   N   N
81400 ACADM   N   N   N
81400 ACE $82.58 Y $82.58 Y $82.58 Y
81400 AGTR1   N   N   N
81400 CCR5   N   N   N
81400 CLRN1   N   N   N
81400 DPYD $81.70 Y $81.70 Y $81.70 Y
81400 DYT1   N   N   N
81400 F13B $70.20 Y $70.20 Y $70.20 Y
81400 F2 NO DATA Y NO DATA Y   Y
81400 F5 $64.52 Y $64.52 Y $64.52 Y
81400 F7 $64.52 Y $64.52 Y $64.52 Y
81400 FGB $70.20 Y $70.20 Y $70.20 Y
81400 FGFR3   N   N   N
81400 Human Platelet Antigen ANTIGEN 1(HPA-1) $46.46 Y $46.46 Y $46.46 Y
81400 Human Platelet Antigen ANTIGEN 2(HPA-2) $46.46 Y $46.46 Y $46.46 Y
81400 Human Platelet Antigen ANTIGEN 3(HPA-3) $46.46 Y $46.46 Y $46.46 Y
81400 Human Platelet Antigen ANTIGEN 4(HPA-4) $46.46 Y $46.46 Y $46.46 Y
81400 Human Platelet Antigen ANTIGEN 5(HPA-5) $46.46 Y $46.46 Y $46.46 Y
81400 Human Platelet Antigen ANTIGEN 6(HPA-6w) $46.46 Y $46.46 Y $46.46 Y
81400 Human Platelet Antigen ANTIGEN 15 (HPA-15) $46.46 Y $46.46 Y $46.46 Y
81400 IVD $46.46 Y $46.46 Y $46.46 Y
81400 IL28B         $55.23 Y
81400 SERPINE1 $58.84 Y $58.84 Y $58.84 Y
81400 SHOC2-NOONAN-LIKE-SYNDROME   N   N   N
81400 SMN1   N   N   N
81400 SRY   N   N   N
81400 TOR1A   N   N   N
81400 COMT   N   N   N

81401 Mole Path Level 2

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81401 ABL1 $153.01 Y $153.01 Y $153.01 Y
81401 ACADM NO DATA N   N   N
81401 ADRB2   N NO DATA N NO DATA N
81401 APOB NO DATA N   N   N
81401 APOE   N NO DATA N NO DATA N
81401 AR (androgen receptor) NO DATA N   N   N
81401 ATN1   N NO DATA N NO DATA N
81401 BCL 1 gene rearrangement           N
81401 CBFB/MYH11 NO DATA N NO DATA N NO DATA N
81401 CBS NO DATA N NO DATA N NO DATA N
81401 CCND1/IGH $93.94 Y $93.94 Y $93.94 Y
81401 CFH/ARMS2   N   N   N
81401 CYP3A4   N   N   N
81401 CYP3A5   N   N   N
81401 CYFB-MYH11 $138.82 Y $138.82 Y $138.82 Y
81401 DMPK   N   N   N
81401 E2A/PBX1 $105.30 Y $105.30 Y $105.30 Y
81401 EML4-ALK $128.48 Y $128.48 Y $128.48 Y
81401 ETV6-RUNX1 $90.31 Y $90.31 Y $90.31 Y
81401 EWSR1/ERG $151.42 Y $151.42 Y $151.42 Y
81401 EWSR1/FLI1 $162.85 Y $162.85 Y $162.85 Y
81401 EWSR1/WT1 $203.84 Y $203.84 Y $203.84 Y
81401 F11 coagulation factor XI $75.88 Y $75.88 Y $75.88 N
81401 FGFR3   N   N   N
81401 FIP1L1-PDGFR $90.82 Y $90.82 Y $90.82 Y
81401 FOXO1/PAX3 $120.75 Y $120.75 Y $120.75 Y
81401 FOXO1/PAX7 $120.75 Y $120.75 Y $120.75 N
81401 FXN (frataxin)   N   N   N
81401 GALT   N   N   N
81401 GY       N   N
81401 H19   N   N   N
81401 HBB $147.81 Y $147.81 Y $147.81 Y
81401 HTT   N   N   N
81401 KCNQ10T1   N   N   N
81401 MEG3/DLK1   N   N   N
81401 MLL/AFF   N   N   N
81401 MLL/MLLT3   N   N   N
81401 MT-ATP6   N   N   N
81401 MTN-ND4, MT-ND6   N   N   N
81401 MT-ND5   N   N   N
81401 MT-RNR1   N   N   N
81401 MT-TK   N   N   N
81401 MT-TL1   N   N   N
81401 MT-TS1   N   N   N
81401 MUTYH $82.07 Y $82.07 Y $82.07 Y
81401 NPM/ALK No Data Y No Data Y No Data Y
81401 PAX8/PPARG $54.19 Y $54.19 Y $54.19 Y
81401 PPRSS1   N   N   N
81401 RUNX1/RUNX1T1 $106.05 Y $106.05 Y $106.05 Y
81401 SEPT9   N   N    
81401 SMN1/SMN2   N   N   N
81401 TPMT $111.61 Y $111.61 Y $111.61 Y
81401 TYMS $169.10 Y $169.10 Y $169.10 Y
81401 VWF $278.18 Y $278.18 Y $278.18 Y

81402 Mole Path Level 3

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81402 CYP21A2   N   N   N
81402 Chromosone 18q   N   N   N
81402 ESR1/PGR   N   N   N
81402 IGH_BCL2, majbpr_mcrbp qul_qun            
81402 KIT $98.13 Y $98.13 Y $98.13 Y
81402 MEFV   N No Data Y No Data Y
81402 MPL $101.45 Y $101.45 Y $101.45 Y
81402 TRD   N   N   N
81402 Uniparenteral Disomy   N   N   N
               

81403 Mole Path Level 4

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81403 ABL1 (c-abl oncogene 1 $156.89 Y $156.89 Y $156.89 Y
81403 ANG (angiogenin, ribonuclease, RNase A family, 5   N   N   N
81403 CEBPA $235.54 Y $235.54 Y $235.54 Y
81403 CEL (carboxyl ester lipase [bile salt-stimulated lipase   N   N   N
81403 DAZ/SRY   N   N   N
81403 EPCAM            
81403 F8 (coagulation factor VIII $81.05 Y $81.05 Y $81.05 Y
81403 FGFR3 (fibroblast growth factor receptor 3   N   N   N
81403 GJB1 (gap junction protein, beta 1) (eg, Charcot-Marie-Tooth X-linked), full gene sequence   N   N   N
81403 HBB (hemoglobin, beta, beta-globin beta thalassemia   N   N   N
81403 HRAS (v-Ha-ras Harvey rat sarcoma viral oncogene homolog Costello syndrome   N   N   N
81403 HRAS1   N   N   N
81403 IDH1 $67.70 Y $67.70 Y $67.70 Y
81403 IDH2 (isocitrate dehydrogenase 2 $67.70 Y $67.70 Y $67.70 Y
81403 JAK2 (Janus kinase 2) $109.14 Y $109.14 Y $109.14 Y
81403 KRAS (v-Ki-ras2 Kirsten rat sarcoma viral oncogene)   N   N   N
81403 MPL (myeloproliferative leukemia virus oncogene, thrombopoietin receptor, TPOR $106.32 Y $106.32 Y $106.32 Y
81403 MT-RNR1 (mitochondrially encoded 12S RNA   N   N   N
81403 MT-TS1 (mitochondrially encoded tRNA serine 1   N   N   N
81403 RET, cv       N    
81403 SMN1 (survival of motor neuron 1, telomeric)   N   N   N
81403 VHL (von Hippel-Lindau tumor suppressor $83.60 Y $83.60 Y $83.60 Y
81403 VWF (von Willebrand factor $284.20 Y $284.20 Y $284.20 Y

81404 Mole Path Level 5

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81404 ACADS (acyl-CoA dehydrogenase   N   N   N
81404 AQP2 (aquaporin 2 [collecting duct])   N   N   N
81404 ARX (aristaless related homeobox)   N   N   N
81404 BTD (biotinidase   N   N   N
81404 CAV3 (caveolin 3) (eg, CAV3-related distal myopathy, limb-girdle muscular dystrophy type 1C), full gene sequence   N   N   N
81404 CDKN2A (cyclin-dependent kinase inhibitor 2A $373.14 Y $373.14 Y $373.14 Y
81404 CLRN1 (clarin 1)   N   N   N
81404 CPT2 (carnitine palmitoyltransferase   N   N   N
81404 CYP1B1 (cytochrome P450, family 1, subfamily B, polypeptide 1)   N   N   N
81404 DMPK (dystrophia myotonica-protein kinase   N   N   N
81404 EGR2 (early growth response 2) (eg, Charcot-Marie-Tooth   N   N   N
81404 FGFR2 (fibroblast growth factor receptor 2)   N   N   N
81404 FGFR3 (fibroblast growth factor receptor 3)   N   N   N
81404 FKRP (Fukutin related protein)   N   N   N
81404 FOXG1 (forkhead box G1)   N   N   N
81404 FSHMD1A (facioscapulohumeral muscular dystrophy 1A)   N   N   N
81404 FSHMD1A (facioscapulohumeral muscular dystrophy 1A)   N   N   N
81404 FXN (frataxin)   N   N   N
81404 HBA1/HBA2 (alpha globin 1 and alpha globin 2)   N   N   N
81404 HBB (hemoglobin, beta, beta-globin)   N   N   N
81404 HNF1B (HNF1 homeobox B) (eg, maturity-onset diabetes of the   N   N   N
81404 HRAS (v-Ha-ras Harvey rat sarcoma viral oncogene homolog)   N   N   N
81404 Huntingtons dz mutation       N   N
81404 KCNJ10 (potassium inwardly-rectifying channel, subfamily J, member 10   N   N   N
81404 KIT (C-kit) (v-kit Hardy-Zuckerman 4 feline sarcoma $213.47 Y $213.47 Y $213.47 Y
81404 LITAF (lipopolysaccharide-induced TNF factor)   N   N   N
81404 MEFV (Mediterranean fever $329.41 Y $213.47 Y $213.47 Y
81404 MEN1 (multiple endocrine neoplasia I   N   N   N
81404 NRAS (neuroblastoma RAS viral oncogene homolog) $148.04 Y $148.04 Y $148.04 Y
81404 PDGFRA (platelet-derived growth factor receptor alpha polypeptide) $111.44 Y $111.44 Y $111.44 Y
81404 PDX1 (pancreatic and duodenal homeobox   N   N   N
81404 PRNP (prion protein   N   N   N
81404 PRSS1 (protease, serine, 1 [trypsin 1])         $248.76 Y
81404 RAF1 (v-raf-murine leukemia viral oncogene homolog 1)   N   N    
81404 RET (RET proto-oncogene)         $94.97 Y
81404 SDHD (succinate dehydrogenase complex, subunit D, integral membrane protein   N   N   N
81404 SLC25A4 (solute carrier family 25 [mitochondrial carrier; adenine nucleotide translocation],   N   N   N
81404 TP53 (tumor protein 53   N   N   N
81404 TTR (transthyretin   N   N   N
81404 TYR (tyrosinase [oculocutaneous albinism IA])   N   N   N
81404 USH1G (Usher syndrome 1G [autosomal recessive])   N   N   N
81404 VHL (von Hippel-Lindau tumor suppressor) $639.96 Y $639.96 Y $639.96 Y
81404 VWF (von Willebrand factor)   N   N   N

81405 Mole Path Level 6

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81405 ABCD1 (ATP-binding cassette, sub-family D [ALD],   N   N   N
81405 ACADS (acyl-CoA dehydrogenase, C-2 to C-3 short chain) (eg, short chain acyl-CoA   N   N   N
81405 ACTC1 (actin, alpha, cardiac muscle 1)   N   N   N
81405 APTX (aprataxin)   N   N   N
81405 AR (androgen receptor)   N   N   N
81405 CHRNA4 (cholinergic receptor, nicotinic, alpha 4)   N   N   N
81405 CHRNB2 (cholinergic receptor, nicotinic, beta 2 [neuronal   N   N   N
81405 CYP21A2 (cytochrome P450, family 21, subfamily A, polypeptide2   N   N   N
81405 DFNB59 (deafness, autosomal recessive 59)   N   N   N
81405 DHCR7 (7-dehydrocholesterol reductase   N   N   N
81405 EYA1 (eyes absent homolog 1 [Drosophila])   N   N   N
81405 F9 (coagulation factor IX)   N   N   N
81405 FH (fumarate hydratase   N   N   N
81405 FKTN (fukutin) (eg, limb-girdle muscular dystrophy   N   N   N
81405 GFAP (glial fibrillary acidic protein)   N   N   N
81405 GLA (galactosidase, alpha   N   N   N
81405 HBA1/HBA2 (alpha globin 1 and alpha globin 2   N   N   N
81405 HNF1A (HNF1 homeobox A   N   N   N
81405 HNF1B (HNF1 homeobox B)   N   N   N
81405 KRAS (v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog)   N   N   N
81405 LAMP2 (lysosomal-associated membrane protein 2)   N   N   N
81405 MEN1 (multiple endocrine neoplasia I $426.32 Y $426.32 Y $426.32 Y
81405 MPZ (myelin protein zero)   N   N   N
81405 MYL2 (myosin, light chain 2, regulatory, cardiac, slow)   N   N   N
81405 MYL3 (myosin, light chain 3, alkali, ventricular, skeletal, slow)   N   N   N
81405 MYOT (myotilin)   N   N   N
81405 NEFL (neurofilament, light polypeptide)   N   N   N
81405 NF2 (neurofibromin 2 [merlin]) (e   N   N   N
81405 NSD1 (nuclear receptor binding SET domain protein 1)   N   N   N
81405 OTC (ornithine carbamoyltransferase)   N   N   N
81405 PDHB (pyruvate dehydrogenase [lipoamide] beta)   N   N   N
81405 PSEN1 (presenilin 1)   N   N   N
81405 RET (RET proto-oncogene) (eg, multiple endocrine neoplasia, type 2A and familial medullary thyroid carcinoma)   N   N $379.47 Y
81405 SDHB (succinate dehydrogenase complex, subunit B, iron sulfur) (eg, hereditary paragangli   N   N   N
81405 SDHC (succinate dehydrogenase complex, subunit C, integral membrane protein, 15kDa)   N   N   N
81405 SGCA (sarcoglycan, alpha [50kDa dystrophin-associated glycoprotein]   N   N   N
81405 SGCB (sarcoglycan, beta [43kDa dystrophin-associated glycoprotein]   N   N   N
81405 SGCD (sarcoglycan, delta [35kDa dystrophin-associated glycoprotein])   N   N   N
81405 SGCG (sarcoglycan, gamma [35kDa dystrophin-associated glycoprotein])   N   N   N
81405 SHOC2 (soc-2 suppressor of clear homolog)   N   N   N
81405 SMN1 (survival of motor neuron 1, telomeric)   N   N   N
81405 SPRED1 (sprouty-related, EVH1 domain containing 1)   N   N   N
81405 TGFBR1 (transforming growth factor, beta receptor 1) (   N   N   N
81405 TGFBR2 (transforming growth factor, beta receptor 2)   N   N   N
81405 THRB (thyroid hormone receptor, beta)   N   N   N
81405 TNNI3 (troponin 1, type 3 [cardiac])   N   N   N
81405 TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome, tumor   N   N   N
81405 TPM1 (tropomyosin 1 [alpha])   N   N   N
81405 TSC1 (tuberous sclerosis 1   N   N   N
81405 VWF (von Willebrand factor) $284.20 Y $278.18 Y $278.18 Y

81406 Mole Path Level 7

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81406 NOTCH3 (notch 3)   N   N   N
81406 RAF1 (v-raf-1 murine leukemia viral oncogene homolog 1)   N   N   N
81406 ACADVL (acyl-CoA dehydrogenase, very long chain) (eg   N   N   N
81406 ACTN4 (actinin, alpha 4)   N   N   N
81406 ANO5 (anoctamin 5)   N   N   N
81406 APP (amyloid beta [A4] precursor protein)   N   N   N
81406 ATP7B (ATPase, Cu++ transporting, beta polypeptide) $538.98 Y $538.98 Y $538.98 Y
81406 BRAF (v-raf murine sarcoma viral oncogene homolog B1)   N   N   N
81406 CAPN3 (Calpain 3)   N   N   N
81406 CBS (cystathionine-beta-synthase)   N   N   N
81406 CDH1 (cadherin 1, type 1, E-cadherin [epithelial])   N   N   N
81406 CDKL5 (cyclin-dependent kinase-like 5)   N   N   N
81406 DLAT (dihydrolipoamide S-acetyltransferase)   N   N   N
81406 DLD (dihydrolipoamide dehydrogenase)   N   N   N
81406 EYA1 (eyes absent homolog 1 [Drosophila])   N   N   N
81406 F8 (coagulation factor VIII)   N   N   N
81406 GAA (glucosidase, alpha; acid)   N   N   N
81406 GALT (galactose-1-phosphate uridylyltransferase)   N   N   N
81406 GCDH (glutaryl-CoA dehydrogenase)   N   N   N
81406 GCK (glucokinase [hexokinase 4])   N   N   N
81406 HADHA (hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/enoyl-CoA hydratase [trifunctional protein] alpha subunit)   N   N   N
81406 HEXA (hexosaminidase A, alpha polypeptide)   N   N   N
81406 HNF4A (hepatocyte nuclear factor 4, alpha)   N   N   N
81406 IVD (isovaleryl-CoA dehydrogenase)   N   N   N
81406 JAG1 (jagged 1) (   N   N   N
81406 LDB3 (LIM domain binding 3) (eg, familial   N   N   N
81406 LMNA (lamin A/C)   N   N   N
81406 MAP2K1 (mitogen-activated protein kinase 1)   N   N   N
81406 MAP2K2 (mitogen-activated protein kinase 2) (   N   N   N
81406 MCCC2 (methylcrotonoyl-CoA carboxylase 2 [beta])   N   N   N
81406 MUTYH (mutY homolog [E. coli])   N   N   N
81406 NF2 (neurofibromin 2 [merlin]) (eg   N   N   N
81406 NSD1 (nuclear receptor binding SET domain protein 1)   N   N   N
81406 OPA1 (optic atrophy 1) (eg, optic atrophy),   N   N   N
81406 PAH (phenylalanine hydroxylase)   N   N   N
81406 PALB2 (partner and localizer of BRCA2)   N   N   N
81406 PAX2 (paired box 2)   N   N   N
81406 PC (pyruvate carboxylase   N   N   N
81406 PCCB (propionyl CoA carboxylase, beta polypeptide   N   N   N
81406 PDHA1 (pyruvate dehydrogenase [lipoamide] alpha1)   N   N   N
81406 PDHX (pyruvate dehydrogenase complex, component   N   N   N
81406 POLG (polymerase [DNA directed], gamma)   N   N   N
81406 POMGNT1 (protein O-linked mannose beta1, 2-N acetylglucosaminyltransferase)   N   N   N
81406 POMT1 (protein-O-mannosyltransferase 1)   N   N   N
81406 POMT2 (protein-O-mannosyltransferase 2) (   N   N   N
81406 PRKAG2 (protein kinase, AMP-activated, gamma 2 non-catalytic subunit)   N   N   N
81406 PSEN2 (presenilin 2[Alzheimer's disease 4])   N   N   N
81406 PTPN11 (protein tyrosine phosphatase, non-receptor type 11)   N   N   N
81406 PYGM (phosphorylase, glycogen, muscle) (   N   N   N
81406 RET (ret-proto-oncogene $168.83 Y $168.83 Y $168.83 Y
81406 RYR1 (ryanodine receptor 1, skeletal)   N   N   N
81406 SLC26A4 (solute carrier family 26, member 4)   N   N   N
81406 SLC9A6 (solute carrier family 9 [sodium/hydrogen exchanger] member 6)   N   N   N
81406 SOS1 (son of sevenless homolog 1)   N   N   N
81406 TAZ (tafazzin)   N   N   N
81406 TNNT2 (troponin T, type 2 [cardiac])   N   N   N
81406 TSC1 (tuberous sclerosis 1)   N   N   N
81406 TSC2 (tuberous sclerosis 2)   N   N   N
81406 UBE3A (ubiquitin protein ligase   N   N   N
81406 VWF (von Willebrand factor)   N   N   N

81407 Mole Path Level 8

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81407 ABCC8 (ATP-binding cassette, sub-family C [CFTR/MRP], member 8)   N   N    
81407 CHD7 (chromodomain helicase DNA binding protein 7)   N   N    
81407 F8 (coagulation factor VIII)   N   N    
81407 JAG1 (jagged 1)   N   N    
81407 MYBPC3 (myosin binding protein C, cardiac)   N   N    
81407 MYH6 (myosin, heavy chain 6, cardiac muscle, alpha)   N   N    
81407 MYH7 (myosin, heavy chain 7, cardiac muscle, beta)   N   N    
81407 MYO7A (myosin VIIA)   N   N    
81407 NOTCH1 (notch 1)   N   N    
81407 OPA1 (optic atrophy   N   N    
81407 PCDH15 (protocadherin-related 15)   N   N    
81407 SCN1A (sodium channel, voltage-gated, type 1, alpha subunit)   N   N    
81407 SCN5A (sodium channel, voltage-gated, type V, alpha subunit)   N   N    
81407 TSC2 (tuberous sclerosis 2)   N   N    
81407 USH1C (Usher syndrome 1C [autosomal recessive, severe])   N   N    

81408 Mole Path Level 9

CPT Code CPT Descriptor 2013 Noridian Coverage DOS 10/01/13 Noridian Coverage DOS 2014 & 2015 Noridian Coverage
81408 ATM (ataxia telangiectasia mutated)   N   N   N
81408 CDH23 (cadherin-related 23)   N   N   N
81408 COL1A1 (collagen, type I, alpha 1)   N   N   N
81408 COL1A2 (collagen, type I, alpha 2)   N   N   N
81408 DYSF (dysferlin, limb girdle muscular dystrophy 2B [autosomal recessive])   N   N   N
81408 FBN1 (fibrillin 1   N   N   N
81408 NF1 (neurofibromin 1)   N   N   N
81408 RYR1 (ryanodine receptor 1, skeletal)   N   N   N
81408 USH2A (Usher syndrome 2A [autosomal recessive, mild])   N   N   N
81408 VWF (von Willebrand factor) (eg, von Willebrand disease types 1 and 3),   N   N   N

 

Last Updated Dec 17, 2015