MPL Gene Tests Coding and Billing Guidelines (CM00078)
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October 30, 2015

MPL Gene Tests Coding and Billing Guidelines (CM00078)

Effective for dates of service on and after June 25, 2013.

MPL gene mutations have been primarily associated with essential thrombocythemia and primary myelofibrosis. However, serology remains the gold standard for testing and treating these conditions. At present the literature does not support that MPL gene testing changes physician treatment or improves patient outcomes. Therefore, MolDX has determined MPL gene testing is a statutorily excluded service. MolDX will also deny panels of tests that include the MPL gene.

To receive a MPL gene sequencing service denial, please submit the following claim information:

  • Select the appropriate CPT code based on gene components tested
    • CPT code 81402 – MPL, common variants
    • CPT code 81403 - MPL, exon 10
  • 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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