COMT (catechol-O-methyltransferase): Coding and Claim Submission Guidelines
Catechol-O-methyltransferase catalyzes the transfer of a methyl group from S-adenosylmethionine to catecholamines, including the neurotransmitters dopamine, epinephrine, and norepinephrine. This O-methylation results in one of the major degradative pathways of the catecholamine transmitters. CGS has determined that there is insufficient evidence to support the required clinical utility for COMT testing as a Medicare benefit category. Accordingly, COMT tests are statutorily excluded tests.
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 COMT must include:
- CPT code 81479 (unlisted molecular pathology)
- HCPCS modifier GY (statutorily non-covered service)
- The appropriate ICD-9-CM code(s)
- The name of test, "COMT":
- Electronic claims: Loop 2400, NTE02, or SV101-7 field
- Paper claims: Block 19
- If the name of the test is not included on the claim and HCPCS modifier GY is not submitted, the claim will be rejected as unprocessable (remark code MA130). Rejected claims must be corrected and resubmitted as new claims.
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
- National Center for Biotechnology Information website