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    MolDx
    Approved Gene Testing (M00041)

    After a review of the current available literature, the MolDX Program has determined that testing for the following genes/gene components meets the Medicare criteria for a covered service.

    CPT codes
    CPT Descriptor
    81206
    BCR/ABL1 gene major bp
    81207
    BCR/ABL1 gene minor bp
    81208
    BCR/ABL1 gene other bp
    81210
    BRAF gene
    81211
    BRCA1 & 2 seq and com dup/del
    81212
    BRCA1 & 2 185&58385&6174 var
    81213
    BRCA1 & 2 uncom dup/del var
    81214
    BRCA1 full seq & com dup/del
    81215
    BRCA1 full gene known fam variant
    81217
    BRCA2 gene known fam variant
    81225
    CYP2C19 gene com  variants
    81226
    CYP2D6 gene com variants
    81235
    EGFR (epidermal growth receptor)(non-small cell lung) gene analyisis, common variants (eg exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q)
    81240
    F2 gene
    81241
    F5 gene
    81245
    FLT3 gene
    81256
    HFE gene
    81261
    IGH gene rearrange amp meth
    81262
    IGH gene rraange dir probe
    81263
    IGH vari regional mutation
    81264
    IGK, gr
    81265
    STR markers specimen anal
    81266
    STR add (for translplants)
    81267
    Chimerism anal no cell selec
    81268
    Chimerism anal w/cell selec
    81270
    JAK2 gene
    81275
    KRAS gene
    81287
    MGMT, ma
    81291
    MTHFR gene
    81292
    MLH1 gene full seq
    81293
    MLH1 gene known variants
    81294
    MLH1 gene dup/delete variant
    81295
    MSH2 gene full seq
    81296
    MSH2, gene known variants
    81297
    MSH2, gene dup/delete variants
    81298
    MSH6 gene full seq
    81299
    MSH6 gene known variants
    81300
    MSH6 gene dup/delete variants
    81401
    MUTYH, cv
    81301
    Microsatellite instability
    81310
    NPM1 gene
    81315
    PML/RAR alpha com breakpoints
    81316
    PML/RAR alpha com 1 breakpoint
    81317
    PMS2 gene full seq analysis
    81318
    PMS2 known familial variants
    81319
    PMS2 gene dup/delete variants
    81321
    PTEN gene analyis, full sequence
    81322
    PTEN, known familial variants
    81323
    PTEN, duplication/deletion
    81332
    SERPINA1 gene, cv
    81340
    TRB @gene rearrange amplify
    81341
    TRB @gene rearrange dirporbe
    81342
    TRG gene rearrangement anal
    81370
    HLA I & II typng lr
    81371
    HLA I & II type verify lr
    81372
    HLA I typing complete lr
    81373
    HLA I typing 1 locus lr
    81374
    HLA I typing 1 antigen lr
    81375
    HLA II typing ag equiv lr
    81376
    HLA II typing 1 locus lr
    81377
    HLA II type 1 ag equiv lr
    81378
    HLA I & II typing hr
    81379
    HLA I typing complete hr
    81380
    HLA I typing 1 locus hr
    81381
    HLA I typing 1 allele hr
    81382
    HLA II typing 1 loc hr
    81383
    HLA II typing 1 allele hr
    81400
    ACE, idv
    81400
    F2
    81400
    F5
    81400
    F7
    81400
    F13B
    81400
    FGB
    81400
    Human Platelet Antigen ANTIGEN 1(HPA-1)
    81400
    Human Platelet Antigen ANTIGEN 2(HPA-2)
    81400
    Human Platelet Antigen ANTIGEN 3(HPA-3)
    81400
    Human Platelet Antigen ANTIGEN 4(HPA-4)
    81400
    Human Platelet Antigen ANTIGEN 5(HPA-5)
    81400
    Human Platelet Antigen ANTIGEN 6(HPA-6)
    81400
    Human Platelet Antigen ANTIGEN 9(HPA-9)
    81400
    Human Platelet Antigen ANTIGEN 15 (HPA-15)
    81400
    IL28B, rs12979860
    81400
    SERPINE1
    81401
    ABL1 (c-abl oncogene 1
    81401
    CCND1/IGH
    81401
    CBFB-MYH11
    81401
    E2A/PBX1
    81401
    EML4-ALK
    81401
    ETV6-RUNX1
    81401
    EWSR1/ERG
    81401
    EWSR1/FLI1
    81401
    EWSR1/WT1
    81401
    F11coagulation factor XI
    81401
    FIP1L1-PDGFR
    81401
    FOXO1/PAX3 ta, quant/qual
    81401
    FOXO1/PAX7 ta, quant/qual
    81401
    MUTYH (mutY homolog [E.coli])
    81401
    PAX8/PPARG
    81401
    RUNX1/RUNX1T1
    81401
    TPMT (thiopurine S-methyltransferase), cv
    81401
    TYMS (thymidylate synthetase), trv
    81401
    VWF (von Willebrand factor), cv
    81402
    IGH_BCL2
    81402
    KIT
    81403
    ABL1 (c-abl oncogene 1)
    81403
    CEBPA
    81403
    F8 (coagulation factor VIII)
    81403
    IDH1
    81403
    IDH2 (isocitrate dehydrogenase 2)
    81403
    JAK2 (Janus kinase 2)
    81403
    Known familial variant
    81403
    VHL (von Hippel-Lindau tumor suppressor)dup_del
    81403
    VWF (von Willebrand factor), tsa
    81404
    CDKN2A (cyclin-dependent kinase inhibitor 2A
    81404
    KIT (C-kit) (v-kit Hardy-Zuckerman 4 feline sarcoma), tga
    81404
    NRAS (neuroblastoma RAS viral oncogene homolog)
    81404
    PDGFRA (platelet-derived growth factor receptor alpha polypeptide), tga (e
    81404
    PRSS1 (protease, serine, 1 [trypsin 1]), fgs
    81404
    VHL (von Hippel-Lindau tumor suppressor), fgs
    81403
    VWF (Type 2A, 2B, 2M and Exon 28)
    81405
    MEN1 (multiple endocrine neoplasia I), fgs
    81405
    VWF (von Willebrand factor), tsa
    81406
    CAPN3 (Calpain 3)
    81403
    RET, kfv
    81404
    RET, cv
    81405
    RET, tsa
    81406
    RET (ret-proto-oncogene), fgs

     

    last updated on 09/17/2014
    ver 1.0.0