CYP1A2 (Cytochrome P450, family 1, subfamilyA, polypeptide 2): Coding and Claim Submission Guidelines
This gene encodes a member of the cytochrome P450 superfamily of enzymes. The cytochrome P450 proteins are monooxygenases which catalyze many reactions involved in drug metabolism and synthesis of cholesterol, steroids and other lipids. The protein encoded by this gene localizes to the endoplasmic reticulum and its expression is induced by some polycyclic aromatic hydrocarbons (PAHs). CGS has determined that there is insufficient evidence to support the required clinical utility for CYP1A2 testing as a Medicare benefit category. Accordingly, CYP1A2 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 CYP1A2 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, "CYP1A2 ":
- 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