OncoCee Coding and Billing Guidelines (CM00080, V2)
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October 28, 2015 - Updated 10.13.17

OncoCee Coding and Billing Guidelines (CM00080, V2)

MolDX has completed a preliminary review of Biocept’s OncoCee, Circulating Tumor Cell (CTC) Assay to detect metastatic disease for breast, prostate, lung, and colon cancer. To date, the assays have insufficient evidence to support reasonable and necessary criteria for Medicare reimbursement. Therefore, MolDX will deny these CTC assay services.

To receive a CTC assay service denial, please submit the following claim information.

Select the appropriate CPT code for the service rendered:

  • 86152
  • 86153
  • 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); Item 19 (paper claim)

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