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January 28, 2015

Molecular Pathology (MoPath): 2015 MoPath Tier 2 Reimbursement

As per Change Request (CR) 8517, CMS released the 2015 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 that the table is sorted by CPT code and then in alphabetical order 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 "returned as unprocessable" (rejected) (remark code MA130). These claims cannot be appealed; correct the claims to include required information and resubmit as new claims.

HCPCS Code

Descriptor

Allowed

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

IL28B, rs12979860

$55.23

81400

SERPINE1, 4G

$58.84

81401

ABL1,T315I

$153.01

81401

CYFB_MYH11, cv

$138.82

81401

CCND1_IGH, ta majbp qual qual

$93.94

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

$105.81

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

IGH_BCL2 majbp & mcr bp

$123.36

81402

KIT, cv

$98.13

81403

ABL1

$156.89

81403

CEBPA, fgs

$235.54

81403

EPCAM, kfv

$93.94

81403

F8, intron 1 and 22a

$81.05

81403

IDH1, exon 4

$67.70

81403

IDH1_ IDH2, exon 4 panel

135.40

81403

IDH2, exon 4

$67.70

81403

JAK2, exon 12 and 13

$109.14

81403

RET, kfv

$93.94

81403

VHL , dup_del

$83.60

81403

VWF, tsa

$300.03

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

RET, cv

$94.97

81404

VHL, fgs

$639.96

81405

MEN1, fgs

$426.32

81405

RET, tsa

$379.47

81405

VWF, tsa 2N

$278.18

81406

CAPN3, fgs

$538.98

81406

RET, fgs

$384.51

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