myPap Billing and Coding Guidelines (M00051,V2)
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October 30, 2015 - Updated 10.13.17

myPap Billing and Coding Guidelines (M00051, V2)

The myPAP™ DNA test, developed to complement a Papanicolaou (Pap) test, confirms a Pap specimen belongs to the patient evaluated for treatment. MolDX agrees the healthcare community should define and follow strict procedures regarding patient and patient specimen identification and handling. Tests performed to measure the quality or control of a process and do not provide information to diagnose or treat a patient illness or injury do not meet the criteria for a Medicare benefit. Therefore, the myPAP test is a statutorily excluded test. Although an Advance Beneficiary Notice (ABN) is not required for a statutory exclusion, providers supplying this test (directly or through a purchased service) should ensure patients understand the test is not a covered benefit.

Providers must register for a Z-Code identification number prior to claim submission. To access the MolDX registry, go to the McKesson Diagnostics Exchange™ located at: https://app.mckessondex.com/#/loginExternal website. Once an ID has been obtained, please submit the following claim information to receive a myPap Medicare service denial:

  • CPT code 84999 – unlisted chemistry procedure
  • 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 DEX Z-code™ identifier adjacent to the CPT code in the comment/narrative field for the following claim field/types:
    • Part A: Line SV202-7 (electronic claim); Block 80 (paper claim)
    • Part B: Loop 2400 or SV101-7 (electronic claim); Box 19 (paper claim)

If you believe your practice has submitted claims and received reimbursement in error, you may take the following corrective actions:

  • Complete a Self-Audit
  • Identify incorrect submissions contain further claim submission errors
  • Consider Self-Disclosure Protocol

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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