April 11, 2013
Cytogenomic Constitutional Microarray Analysis: Coding and Claim Submission Guidelines
CGS has determined that cytogenomic constitutional microarray analysis is not a Medicare covered service. Screening in the absence of signs and symptoms of an illness or injury is not defined as a Medicare benefit. Therefore, CGS will deny cytogenomic constitutional microarray analysis as a statutorily excluded service.
The following cytogenomic constitutional microarray analysis services have been identified as non-covered:
Test |
---|
Cytogenomic SNP Microarray |
Cytogenomic SNP Microarray Buccal Swab |
Genomic Alterations, Prenatal, Clarisure Oligo-SNP Array |
Genomic Alterations, Postnatal, ClariSure(R) Oligo-SNP (Follow-up) |
Signature PrenatalChip®OS + SNP - Cultured Amnio/CVS |
Signature PrenatalChip®OS + SNP - Direct Amnio/CVS |
Signature PrenatalChip®TE + SNP - Culture Amnio/CVS |
Signature PrenatalChip®TE + SNP - Direct Products of Conception or Tissue |
Signature PrenatalChip®TE +SNP - Prenatal blood |
Signature PrenatalChip®TES + SNP - DNA |
SignatureChipOS® + SNP - DNA |
SignatureChipOS® + SNP - Peripheral Blood |
SNP Array CGH |
Health care providers are not required to submit claims to Medicare for statutorily non-covered services; however, you may choose to submit claims (e.g., at the patient's request). Claims for cytogenomic constitutional microarray analysis must include:
- For dates of service prior to January 1, 2013: appropriate CPT code(s) for the test
- For dates of service on or after January 1, 2013: CPT code 81228 or 81229
- HCPCS modifier GY (statutorily non-covered service)
- The appropriate ICD-9-CM code(s)
- The name of the test:
- Electronic claims: Loop 2400, NTE02, or SV101-7 field
- Paper claims: Block 19
Reference:
- Definition of "reasonable and medically necessary": Social Security Act, section 1862(a)(1)(A)
- Exception to mandatory claim submission for "categorically excluded services": CMS MLN Matters article SE0908, "Mandatory Claims Submission and Its Enforcement"
- Guidance on issuing Advance Beneficiary Notices of Noncoverage (ABNs) on a voluntary basis for statutorily excluded services: CMS Beneficiary Notices Initiative Web page – Fee-For-Service (FFS) ABN