October 27, 2015
SEPT9 Gene Test Coding and Billing Guidelines (CM00063)
The MolDX team has determined that a Septin 9 methylation analysis test for colorectal cancer detection is not a Medicare covered service. Screening in the absence of signs and symptoms of an illness or injury is not defined as a Medicare benefit. Therefore, MolDX will deny Septin 9 methylation analysis tests as a statutorily excluded service.
To receive a SEPT9 service denial, please submit the following claim information:
- CPT code 81401- SEPT9 methylation analysis
- An Advance Beneficiary Notice of Non-Coverage (ABN)
is not required for statutorily excluded services.
- For a voluntary issued ABN, append with HCPCS modifier GX
- To indicate a valid ABN is on file for a known statutorily excluded service, append with HCPCS modifier GY
- Select the appropriate diagnosis for the patient
- Enter the appropriate identifier adjacent to the CPT code in the comment/narrative field for the following claim field/types:
- Part A: Loop 2300 NTE 01 (electronic claim); Form Locator 80 (paper claim)
- Part B: Loop 2400 or SV101-7 (electronic claim); Item 19 (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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