October 20, 2015
LPA-Aspirin Genotype Coding and Billing Guidelines (CM00043)
The MolDX Team has completed a review of the research on the LPA-Aspirin genotype test, developed to predict increased CVD risk and event reduction during aspirin therapy. To date, there is insufficient evidence to support the required clinical utility for the established Medicare benefit category. Therefore, the LPA-Aspirin genotype test a statutorily excluded test.
As reviewed, the developer described the indication to perform a LPA-Aspirin genotype test as a risk assessment for developing a disease or condition. Risk assessment for developing a disease or condition in the absence of signs and symptoms of an illness or injury is also not defined as a Medicare benefit. Therefore, the LPA-Aspirin genotype test would continue to be a statutory excluded test.
To receive a LPA-Aspirin 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 the appropriate Identifier adjacent to the CPT code for the test in the comment/narrative field for the following claim field/types:
Loop 2300 NTE01 for Part A or Loop 2400 or SV101-7 for the 5010A1 837P part B
Form locator 80 for Part A or Box 19 for Part B paper claim
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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