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January 19, 2016

Short Tandem Repeat (STR) Markers and Chimerism Coding and Billing Guidelines (CM00095)

Please note that CPT codes 81265 and 81266 describe services performed for recipient/donor testing and twin zygosity. Laboratories are encouraged to register tests based on the use of the test. Through the MolDX identification process, tests registered for recipient/donor testing will be considered for payment and tests for twin zygosity will be denied as a statutorily excluded service. The following instructions outline the correct reporting of recipient/donor testing for transplant services.

  • Chimerism analysis to identify appropriate donors and monitor engraftment success or disease reoccurrence is a covered Medicare service.
  • CPT code 81265 should be reported with one unit of service (UOS). Except in rare cases, this service would only be performed once per lifetime.
  • CPT code 81266, when used in bone marrow transplants to report an additional double-cord blood sample, is a covered service. 
  • CPT code 81267 should be used post transplantation to confirm successful engraftment or disease reoccurrence. Although the original donor specimen may be referenced, an additional CPT code 81265 should NOT be submitted in addition to CPT code 81267. For labs that hold the pre-transplant specimen (CPT codes 81265 and/or 81266) until after the transplant occurs, use CPT codes 81267 plus 81265 and 81266 if necessary.

Note: CPT code 81267 should be reported for the findings of the pre and post-transplant comparison.

  • CPT code 81268 should be used to report chimerism using a buccal or other germline tissue specimen from the recipient post-transplantation. For labs that hold the pre-transplant specimen (CPT codes 81265 and/or 81266) until after the transplant occurs, use CPT codes 81267 plus 81265 and 81266 if necessary.

MolDX would not expect to see a claim for CPT code 81265 pre-transplant and an additional CPT code 81265 and 81267 post-transplant or a claim for CPT code 81265 pre-transplant and an additional claim for CPT code 81268.

EXCEPTIONS: Although the initial chimerism testing, CPT code 81265, for engraftment is usually limited to once in a lifetime, MolDX recognizes special circumstances may require an additional service and will consider approval on a case-by-case basis through the appeal process.

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