CHD7 Gene Analysis Coding and Billing Guidelines (CM00062)
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October 27, 2015

CHD7 Gene Analysis Coding and Billing Guidelines (CM00062)

Effective for dates of service on and after June 26, 2013.

CHD7 gene testing may be performed during the diagnosis of CHARGE Syndrome. Since clinical symptoms and diagnosis usually occur prior to Medicare eligibility and carrier testing is not a covered benefit, the MolDX team has determined CHD7 gene testing is a statutorily excluded service. MolDX will also deny tests that include one or more of CHD7 tests reported with CPT code 81479 as statutorily excluded services.

To receive a CHD7 analysis service denial, please submit the following claim information:

  • Select appropriate CPT code
    • CPT code 81407 CHD7, full gene sequencing
    • CPT code 81479 all other CHD7 testing
  • An Advance Beneficiary Notice of Non-Coverage (ABN)External Website 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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