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February 14, 2014

Molecular Pathology (MoPath): 2014 MoPath Tier 2 Reimbursement

As per Change Request (CR) 8517, CMS released the 2014 clinical laboratory fee schedule for tests reported with Tier 1 CPT codes. The following table includes the fees established for Tier 2 covered tests. Please note the genes are sorted by CPT code and then by alpha per gene. For Tier 2 codes, multiple genes are listed under a single code. The required identifier assigned and submitted with each test enables CGS to apply the appropriate fee for the specific test performed.

Important: Before you submit claims for molecular pathology tests, reference the "Descriptor" (column 2, in the following table). This column lists key components needed to adjudicate the claim.

To submit claims for MoPath services, enter the appropriate descriptor as follows:

  • Electronic claims: Loop 2400, NTE02, or SV101-7 field
  • Paper claims: Item 19

Claims submitted without the required descriptor information will be rejected as invalid claims (remark code MA130). These claims cannot be appealed; correct the claims to include required information and resubmit as new claims.

CPT code Descriptor Allowed
81287 MGMT $83.01
81400 ACE, idv $82.58
81400 F13B, V34L $64.52
81400 F2, 1199G>A $70.20
81400 F5, HR2 $58.84
81400 F7, R353Q $64.52
81400 FGB, -455G>A $70.20
81400 HPA, antigen ea $46.46
81400 SERPINE1, 4G $58.84
81401 ABL1, T315I $153.01
81401 CCND1_IGH, ta majbp qual qual $93.94
81401 CYFB_MYH11, cv $138.82
81401 E2A_PBX1, ta qual quan, $105.30
81401 EML4_ALK, ta or ia $128.48
81401 ETV6_RUNX1, ta qual quan $90.31
81401 EWSR1_ERG, ta qual quan $151.42
81401 EWSR1_FLI1, ta qual quan $162.85
81401 EWSR1_WT1, ta qual quan $203.84
81401 F11, cv $75.88
81401 FIP1L1_PDGFR, qual quan $90.82
81401 FOXO1_PAX3, ta, qual quan $120.75
81401 FOXO1_PAX7, ta, qual quan $120.75
81401 MUTYH, cv $82.07
81401 PAX8_PPARG, ta $54.19
81401 RUNX1_RUNX1T1, ta qual quan $106.05
81401 TPMT, cv $111.61
81401 TYMS, trv $169.10
81401 VWF, cv (2N) $278.18
81402 KIT, cv $98.13
81403 ABL1 $156.89
81403 CEBPA, fgs $235.54
81403 F8, intron 1 and 22a $81.05
81403 IDH1, exon 4 $67.70
81403 IDH2, exon 4 $67.70
81403 JAK2, exon 12 and 13 $109.14
81403 VHL , dup_del $83.60
81403 VWF, tsa (2A, 2B, 2M: exon 28) $284.20
81404 CDKN2A, fgs $373.14
81404 KIT, tga $213.47
81404 NRAS, exon 1, 2 $148.04
81404 PDGFRA, tsa $111.44
81404 PRSS1, fgs $248.76
81404 VHL, fgs $639.96
81405 MEN1, fgs $426.32
81405 VWF, tsa $292.63
81406 CAPN3, fgs $538.98
81406 RET, fgs $168.83

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