BluePrint Coding and Billing Guidelines (CM00045)
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October 20, 2015

BluePrint Coding and Billing Guidelines (CM00045)

MolDX has completed a technical assessment on BluePrint®, a molecular subtyping assay. To date, there is insufficient evidence to support the required clinical utility for the established Medicare benefit category. Therefore, the BluePrint test is a statutorily excluded test.

To receive a BluePrint® service denial, please submit the following claim information:

CPT code 81479- Unlisted molecular pathology procedure

An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services

For a voluntary issued ABN, append with GX modifier

To indicate a statutorily excluded service, append with a GY modifier

Select the appropriate diagnosis for the patient

Enter appropriate Z-Code ID adjacent to the CPT code in the comment/narrative field for the following claim field/types:

Loop 2300 NTE 01 for Part A or Loop 2400 or SV101-7 for the 5010A1 837P for Part B

Form locator 80 for Part A or Box 19 for Part B paper claim. (Note: Only one test/identifier per paper claim may be submitted)

Reference: Sec. 1862 (1)(A) Statutory Exclusion covers diagnostic testing "except for items and services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member,…"


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