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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.

    OB

    CPT

    CPT Descriptor

    1.

    81206

    BCR/ABL, p210

    2.nbsp;

    81207

    BCR/ABL1, p190

    3.

    81208

    BCR/ABL1, other bp

    4.

    81210

    BRAF, V600E

    5.

    81211

    BRCA1 & 2, fgs com dup/del

    6.

    81212

    BRCA1 & 2, 185&58385&6174 var

    7.

    81213

    BRCA1 & 2, uncom dup/del

    8.

    81214

    BRCA1, fgs cdup/del

    9.

    81225

    Cyp2c19, cv

    10.

    81226

    Cyp2d6, cv

    11.

    81235

    EGFR, cv

    12.

    81240

    F2, 20210G>A

    13.

    81241

    F5, Leiden

    14.

    81245

    FLT3, dup

    15.

    81256

    HFE, cv

    16.

    81261

    IGH, amp

    17.

    81262

    IGH, dp

    18.

    81263

    IGH, variable regional

    19.

    81264

    IGK, gr

    20.

    81265

    STR markers specimen anal

    21.

    81266

    STR add(for transplants)

    22.

    81267

    Chimerism anal no cell selec

    23.

    81268

    Chimerism anal w/cell selec

    24.

    81270

    JAK2, V617F

    25.

    81275

    KRAS, codons 12, 13

    26.

    81287

    MGMT, ma

    27.

    81291

    MTHFR, cv

    28.

    81292

    MLH1, fgs

    29.

    81293

    MLH1, kfv

    30.

    81294

    MLH1, dup/del

    31.

    81295

    MSH2, fgs

    32.

    81296

    MSH2, kfv

    33.

    81297

    MSH2, dup/delete

    34.

    81298

    MSH6, fgs

    35.

    81299

    MSH6, kfv

    36.

    81300

    MSH6, dup/del

    37.

    81401

    MUTYH, cv

    38.

    81301

    Microsatellite instability

    39.

    81310

    NPM1, ex12

    40.

    81315

    PML/RAR, cbp quant/qual

    41.

    81316

    PML/RAR, sbp quant/qual

    42.

    81317

    PMS2, fgs

    43.

    81318

    PMS2, kfv

    44.

    81319

    PMS2, dup/del

    45.

    81321

    PTEN, fgs

    46.

    81322

    PTEN, kfv

    47.

    81323

    PTEN, dup/del

    48.

    81332

    SERPINA1, cv

    49.

    81340

    TRB, beta amp

    50.

    81341

    TRB, dp

    51.

    81342

    TRG, gamma

    52.

    81370

    HLA I & II typing lr

    53.

    81371

    HLA I & II type verify lr

    54.

    81372

    HLA I typing complete lr

    55.

    81373

    HLA I typing 1 locus lr

    56.

    81374

    HLA I typing 1 antigen lr

    57.

    81375

    HLA II typing ag equiv lr

    58.

    81376

    HLA II typing 1 locus lr

    59.

    81377

    HLA II type 1 ag equiv lr

    60.

    81378

    HLA I & II typing hr

    61.

    81379

    HLA I typing complete hr

    62.

    81380

    HLA I typing 1 locus hr

    63.

    81381

    HLA I typing 1 allele hr

    64.

    81382

    HLA II typing 1 loc hr

    65.

    81383

    HLA II typing 1 allele hr

    66.

    81400

    ACE, idv

    67.

    81400

    F2, 1199G>A

    68.

    81400

    F5, HR2

    69.

    81400

    F7, R353Q

    70.

    81400

    F13B, V34L

    71.

    81400

    FGB, -455G>A

    72.

    81400

    Human Platelet Antigen ANTIGEN 1(HPA-1)

    73.

    81400

    Human Platelet Antigen ANTIGEN 2(HPA-2)

    74.

    81400

    Human Platelet Antigen ANTIGEN 3(HPA-3)

    75.

    81400

    Human Platelet Antigen ANTIGEN 4(HPA-4)

    76.

    81400

    Human Platelet Antigen ANTIGEN 5(HPA-5)

    77.

    81400

    Human Platelet Antigen ANTIGEN 6(HPA-6)

    78.

    81400

    Human Platelet Antigen ANTIGEN 9(HPA-9)

    79.

    81400

    Human Platelet Antigen ANTIGEN 15 (HPA-15)

    80.

    81400

    SERPINE1, 4G

    81.

    81401

    ABL1, T3153

    82.

    81401

    CCND1/IGH

    83.

    81401

    CBFB-MYH11

    84.

    81401

    E2A/PBX1

    85.

    81401

    EML4-ALK

    86.

    81401

    ETV6-RUNX1

    87.

    81401

    EWSR1/ERG

    88.

    81401

    EWSR1/FLI1

    89.

    81401

    EWSR1/WT1

    90.

    81401

    F11, cv

    91.

    81401

    FIP1L1-PDGFR

    92.

    81401

    FOXO1/PAX3 ta, quant/qual

    93.

    81401

    FOXO1/PAX7 ta, quant/qual

    94.

    81401

    MUTYH, cv

    95.

    81401

    PAX8/PPARG, ta

    96.

    81401

    RUNX1/RUNX1T1

    97.

    81401

    TPMT, cv

    98.

    81401

    TYMS, trv

    99.

    81401

    VWF, cv

    100.

    81402

    IGH_BCL2

    101.

    81402

    KIT

    102.

    81403

    ABL1, kinase domain variants

    103.

    81403

    CEBPA

    104.

    81403

    F8, intron 1 & 22a

    105.

    81403

    IDH1, ex4

    106.

    81403

    IDH2, ex4

    107.

    81403

    JAK2, ex 12 & 13

    108.

    81403

    Known familial variant, NOC

    109.

    81403

    RET, kfv

    110.

    81403

    VHL, dup_del

    111.

    81403

    VWF, tsa

    112.

    81404

    CDKN2A, fgs

    113.

    81404

    KIT, tga

    114.

    81404

    NRAS, ex 1 & 2

    115.

    81404

    PDGFRA, tga

    116.

    81404

    PRSS1, fgs

    117.

    81404

    RET, cv

    118.

    81404

    VHL, fgs

    119.

    81404

    VWF, tsa

    120.

    81405

    MEN1, fgs

    121.

    81405

    RET, tsa

    122.

    81405

    VWF, tsa

    123.

    81406

    CAPN3

    124.

    81406

    RET, fgs

     

     

    last updated on 12/09/2014
    ver 1.0.0