February 13, 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 | Descriptor | Allowed |
---|---|---|
81400 | ACE, idv | $82.58 |
81400 | F13B, V34L | $64.25 |
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 | CBFB_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 | $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 | $169.10 |
81401 | VWF, cv | $278.18 |
81402 | IGH_BCL2, majbpr_mcrbp qul_qun | $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 2A, 2B, 2M | $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 | RET, fgs | $384.51 |