Medical Policy and Coding Updates

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    We regularly review policies to make sure they’re consistent with the latest medical evidence. We'd like your feedback on policies scheduled for review. In the document, you can open any title to read the current policy. Email us your policy comments or suggestions today!

  • Effective February 1, 2019

    Cervical Spine Surgeries: Discectomy, Laminectomy, and Fusion in Adults, 7.01.560
    The policy is updated to include statements for posterior cervical fusion, cervical discectomy, and cervical laminectomy. Title is changed to Cervical Spine Surgeries: Discectomy, Laminectomy, and Fusion in Adults.

    Corneal Collagen Cross‐Linking, 9.03.28
    This policy is being reinstated. Corneal collagen cross-linking using riboflavin and ultraviolet A is considered medically necessary as a treatment of progressive keratoconus or corneal ectasia after refractive surgery in those who have failed conservative treatment. It is investigational for all other indications.

    Hereditary Angioedema – Medical, 5.01.587
    This policy now lists the medical necessity criteria for the following drugs for hereditary angioedema which are covered by the medical benefit:

    • For treatment of acute attacks: Berinert® (pdC1-INH), Kalbitor® (ecallantide), Ruconest® (rhC1-INH)
    • For long-term prophylaxis of acute attacks: Cinryze® (pdC1-INH)

    Drugs covered by the pharmacy benefit are moved to policy 5.01.594.

    Trogarzo™ (ibalizumab), 5.01.588
    Trogarzo™ (ibalizumab) may be considered medically necessary in the treatment of HIV-1 patients when criteria are met.

    New medical policies

    Effective January 1, 2019

    Dry Needling of Myofascial Trigger Points, 2.01.100
    Dry needling of trigger points for the treatment of myofascial pain is considered investigational.

    Effective January 4, 2019

    Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer, 2.04.514
    Protein biomarkers for the diagnosis of prostate cancer are investigational. Apinifi is added as an investigational test. This policy was previously numbered 12.04.33.

    Plasma-Based Proteomic Screening in the Management of Pulmonary Nodules, 2.04.515
    Plasma-based proteomic testing in individuals with undiagnosed pulmonary nodules detected by computed tomography is considered investigational. This policy was previously numbered 12.04.142.

    Revised medical policies

    Effective January 1, 2019

    Dopamine Transporter Imaging with Single-Photon Emission Computed Tomography, 6.01.54
    The policy is revised to state that DAT-SPECT may be considered medically necessary for clinically uncertain Parkinson disease and clinically uncertain dementia with Lewy bodies. All other indications are considered investigational.

    Durable Medical Equipment, 1.01.526
    Coverage criteria are added for the repair and replacement of positive airway pressure devices.

    Immune Globulin Therapy, 8.01.503
    The policy is revised to add a statement of medical necessity for the indications of specific antibody deficiency (SAD) and CAR-T cell therapy.

    Sublingual Immunotherapy as a Technique of Allergen-Specific Therapy, 2.01.17
    The policy is revised to add a statement that Odactra™ may be considered medically necessary for the treatment of house dust mite-induced allergic rhinitis or rhinoconjunctivitis when criteria are met.

    Effective January 4, 2019

    Genetic Testing: Services Reviewed by AIM®, 10.01.526
    The policy clarifies rationale for genetic counseling requirements.

    New pharmacy policies

    Effective December 20, 2018

    Hereditary Angioedema – Pharmacy, 5.01.594
    This policy lists the medical necessity criteria for the following drugs for hereditary angioedema. These drugs were originally listed in policy 5.01.587 and are moved into this policy because they are covered by the pharmacy benefit:

    • For treatment of acute attacks: Firazyr® (icatibant)
    • For long-term prophylaxis of acute attacks: Haegarda® (pdC1-INH), Takhyzro® (lanadelumab)

    Revised pharmacy policies

    Effective January 1, 2019

    Dupixent (dupilumab), 5.01.517
    This policy is revised to add medical necessity criteria for moderate-to-severe asthma. Policy title is changed.

    CGRP Inhibitors for Migraine Prophylaxis, 5.01.584
    Medical necessity criteria are added for Emgality™ (galcanezumab).

    Granulocyte Colony Stimulating Factor (G-CSF) Use in Adult Patients, 5.01.551
    The policy adds medical necessity criteria for Udenyca® (pegfilgrastim-cbqv). Nivestym™ (filgrastim-aafi) is added as first-line therapy.

    Pharmacotherapy of Inflammatory Bowel Disorder, 5.01.563
    The policy clarifies that for the indication of ulcerative colitis using Humira® (adalimumab) SC, Remicade® (infliximab) IV, Entyvio® (vedolizumab) IV, Inflectra® (infliximab-dyyb) IV, and Renflexis® (infliximab-abda), the patient tries therapy with ONE of the following medications: an antibiotic (eg metronidazole, ciprofloxacin), probiotic, corticosteroid enema/suppository, mesalamine enema/suppository.

    Rituxan® (rituximab): Non-Oncologic and Miscellaneous Uses, 5.01.556
    Rituxan may be considered medically necessary for idiopathic membranous nephropathy when criteria are met.

    A deleted policy is one whose number is no longer used but the content is either moved into another policy or replaced with a new policy and number.

    Deleted January 4, 2019

    Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer, 12.04.33. Policy is renumbered as 2.04.514.

    Molecular Testing in the Management of Pulmonary Nodules, 12.04.142. Policy is renumbered as 2.04.515.

    An archived policy is one that's no longer active and is not used for reviews.

    Archived January 4, 2019. Services in these policies are now reviewed by AIM Specialty Health®.

    • 2.04.07 Urinary Biomarkers for Cancer Screening, Diagnosis, and Surveillance
    • 2.04.68 Laboratory and Genetic Testing for Use of 5-Fluorouracil in Patients with Cancer
    • 4.01.21 Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions using Cell-Free Fetal DNA
    • 12.04.13 Genetic Testing for Alzheimer Disease
    • 12.04.28 Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
    • 12.04.36 Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer
    • 12.04.43 Genetic Testing for Cardiac Ion Channelopathies
    • 12.04.44 Genetic Testing for Familial Cutaneous Malignant Melanoma
    • 12.04.48 Genotype-Guided Warfarin Dosing
    • 12.04.51 Genetic Testing for Tamoxifen Treatment
    • 12.04.52 Molecular Testing for the Management of Pancreatic Cysts, Barrett Esophagus, and Solid Pancreaticobiliary Lesions
    • 12.04.54 Gene Expression-Based Assays for Cancers of Unknown Primary
    • 12.04.59 Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies
    • 12.04.61 Multigene Expression Assay for Predicting Recurrence in Colon Cancer
    • 12.04.63 Use of Common Genetic Variants (Single Nucleotide Variants) to Predict Risk of Non-Familial Breast Cancer
    • 12.04.72 Gene Expression Testing in the Evaluation of Patients with Stable Ischemic Heart Disease
    • 12.04.74 DNA-Based Testing for Adolescent Idiopathic Scoliosis
    • 12.04.75 Genetic Testing of CADASIL Syndrome
    • 12.04.81 Genetic Testing for Rett Syndrome
    • 12.04.86 Genetic Testing for Muscular Dystrophies
    • 12.04.87 Genetic Testing for Hereditary Hearing Loss
    • 12.04.88 Genetic Testing for PTEN Hamartoma Tumor Syndrome
    • 12.04.89 Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
    • 12.04.91 General Approach to Genetic Testing
    • 12.04.93 Genetic Cancer Susceptibility Panels Using Next-Generation Sequencing
    • 12.04.97 Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification
    • 12.04.99 Genetic Testing for Hereditary Pancreatitis
    • 12.04.102 Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders
    • 12.04.103 Genetic Testing for Macular Degeneration
    • 12.04.108 Noninvasive Fetal RHD Genotyping Using Cell-Free Fetal DNA
    • 12.04.111 Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
    • 12.04.114 Genetic Testing for Dilated Cardiomyopathy
    • 12.04.115 Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies
    • 12.04.117 Genetic Testing for Mitochondrial Disorders
    • 12.04.120 Gene Expression Profiling for Uveal Melanoma
    • 12.04.121 Miscellaneous Genetic and Molecular Diagnostic Tests
    • 12.04.122 Chromosomal Microarray Testing for the Evaluation of Pregnancy Loss
    • 12.04.126 Moderate Penetrance Variants Associated with Breast Cancer in Individuals at High Breast Cancer Risk
    • 12.04.129 Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders
    • 12.04.131 Pharmacogenetic Testing for Pain Management
    • 12.04.139 Genetic Testing for Heterozygous Familial Hypercholesterolemia
    • 12.04.140 Proteogenomic Testing in Patients with Cancer
    • 12.04.141 Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy)
    • 12.04.146 Gene Expression Profiling for Cutaneous Melanoma
    • 12.04.305 Preimplantation Genetic Testing in Embryos
    • 12.04.504 Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome (BRCA1/BRCA2)
    • 12.04.506 Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
    • 12.04.510 Molecular Markers in Fine Needle Aspirates of the Thyroid
    • 12.04.512 Genetic Testing for Li-Fraumeni Syndrome
    • 12.04.514 Genetic Testing for Epilepsy
    • 12.04.515 Genetic Testing for Diagnosis and Management of Mental Health Conditions
    • 12.04.517 CYP450 Genotyping to Determine Drug Metabolizer Status
    • 12.04.518 Preconception Screening for Carrier Status of Genetic Diseases
    • 12.04.519 Genetic Testing for Alpha Thalassemia
    • 12.04.520 General Approach to Evaluating the Utility of Genetic Panels
    • 12.04.522 Genetic Testing for Neurofibromatosis
    • 12.04.523 Invasive Prenatal (Fetal) Diagnostic Testing

    Added codes

    Effective January 1, 2019

    Adoptive Immunotherapy, 8.01.01
    Not reviewed, noncovered service

    0537T - Chimeric antigen receptor t-cell (car-t) therapy; harvesting of blood-derived t lymphocytes for development of genetically modified autologous car-t cells, per day

    0538T - Chimeric antigen receptor t-cell (car-t) therapy; preparation of blood-derived t lymphocytes for transportation (eg, cryopreservation, storage)

    0539T - Chimeric antigen receptor t-cell (car-t) therapy; receipt and preparation of car-t cells for administration

    0540T - Chimeric antigen receptor t-cell (car-t) therapy; car-t cell administration, autologous

    Adoptive Immunotherapy, 8.01.01
    Now reviewed for medical necessity, now requires prior authorization

    Q2042 - Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose

    Amniotic Membrane and Amniotic Fluid, 7.01.149
    Now reviewed for investigative

    Q4189 - Artacent ac, 1 mg
    Q4190 - Artacent ac, per square centimeter
    Q4183 - Surgigraft, per square centimeter
    Q4184 - Cellesta, per square centimeter
    Q4185 - Cellesta flowable amnion (25 mg per cc); per 0.5 cc
    Q4188 - Amnioarmor, per square centimeter
    Q4191 - Restorigin, per square centimeter
    Q4192 - Restorigin, 1 cc
    Q4193 - Coll-e-derm, per square centimeter
    Q4194 - Novachor, per square centimeter
    Q4198 - Genesis amniotic membrane, per square centimeter

    Amniotic Membrane and Amniotic Fluid, 7.01.149
    Now reviewed for medical necessity, now requires prior authorization

    Q4186 - Epifix, per square centimeter
    Q4187 - Epicord, per square centimeter

    Antibody-Drug Conjugate, 5.01.582
    Now reviewed for medical necessity, now requires prior authorization

    J9229 - Injection, inotuzumab ozogamicin, 0.1 mg

    Bioengineered Skin and Soft Tissue Substitutes, 7.01.113
    Now reviewed for investigative

    Q4195 - Puraply, per square centimeter
    Q4196 - Puraply am, per square centimeter
    Q4197 - Puraply xt, per square centimeter
    Q4200 - Skin te, per square centimeter
    Q4201 - Matrion, per square centimeter
    Q4202 - Matrion, per square centimeter
    Q4203 - Derma-gide, per square centimeter
    Q4204 - Xwrap, per square centimeter

    Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting, 2.02.24
    Now reviewed for investigative

    33289 - Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart

    93264 - Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recordings, interpretation(s), trend analysis, and report

    Chelation Therapy, 8.01.535
    Now reviewed for medical necessity

    G0068 - Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, and/or inotropic infusion drug(s) for each infusion drug administration calendar day in the individual's home, each 15 minutes

    Drugs for Rare Diseases, 5.01.576
    Now reviewed for medical necessity including site of service, now requires prior authorization

    J0584 - Injection, burosumab-twza 1 mg

    Focal Treatments for Prostate Cancer, 8.01.61
    Now reviewed for investigative

    53854 - Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy

    Gene Therapy for Inherited Retinal Dystrophy, 2.04.144
    Now reviewed for medical necessity, now requires prior authorization

    J3398 - Injection, voretigene neparvovec-rzyl, 1 billion vector genomes

    Granulocyte Colony-Stimulating Factor (G-CSF) Use in Adult Patients, 5.01.551
    Now reviewed for medical necessity, now requires prior authorization

    Q5110 - Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram

    Hemlibra® (emicizumab-kxwh), 5.01.581
    Now reviewed for medical necessity, now requires prior authorization

    J7170 - Injection, emicizumab-kxwh, 0.5 mg

    Home Enteral Nutrition, 8.01.502
    Now reviewed for investigative

    B4105 - In-line cartridge containing digestive enzyme(s) for enteral feeding, each

    IL-5 Inhibitors, 5.01.559
    Now reviewed for medical necessity, now requires prior authorization

    J0517 - Injection, benralizumab, 1 mg

    Intra-Articular Hyaluronan Injections for Osteoarthritis, 2.01.31
    Now reviewed for medical necessity

    J7318 - Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg
    J7329 - Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg

    Monoclonal Antibodies for the Treatment of Lymphoma, 2.03.502
    Now reviewed for medical necessity including site of service, now requires prior authorization

    J9311 - Injection, rituximab 10 mg and hyaluronidase
    J9312 - Injection, rituximab, 10 mg

    Myoelectric Prosthetic and Orthotic Components for the Upper Limb, 1.04.502
    Now reviewed for investigative

    L8701 - Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated

    L8702 - Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated

    Non-covered Services and Procedures, 10.01.517
    Not reviewed, noncovered service

    A4563 - Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each

    T4545 - Incontinence product, disposable, penile wrap, each

    Pharmacotherapy of Arthropathies, 5.01.550
    Now reviewed for medical necessity, now requires prior authorization

    J3245 - Injection, tildrakizumab, 1 mg

    Pharmacotherapy of Arthropathies, 5.01.550
    Now requires review for medical necessity including site of service, now requires prior authorization

    Q5109 - Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg

    Phosphoinositide 3-kinase (PI3K) Inhibitors, 5.01.592
    Now reviewed for medical necessity including site of service, now requires prior authorization

    J9057 - Injection, copanlisib, 1 mg

    Radicava® (edaravone), 5.01.578
    Now reviewed for medical necessity, now requires prior authorization

    J1301 - Injection, edaravone, 1 mg

    Subtalar Arthroereisis, 7.01.104
    Now reviewed for investigative

    0510T - Removal of sinus tarsi implant
    0511T - Removal and reinsertion of sinus tarsi implant

    Therapeutic Radiopharmaceuticals in Oncology, 6.01.60
    Now reviewed for medical necessity, now requires prior authorization

    A9513 - Lutetium lu 177, dotatate, therapeutic, 1 millicurie

    Treatment of Varicose Veins/Venous Insufficiency, 7.01.519
    Now reviewed for medical necessity, now requires prior authorization

    0524T - Endovenous catheter directed chemical ablation with balloon isolation of incompetent extremity vein, open or percutaneous, including all vascular access, catheter manipulation, diagnostic imaging, imaging guidance and monitoring

    Use of Vascular Endothelial Growth Factor Receptor (VEGF) Inhibitors and Other Angiogenesis Inhibitors in Oncology Patients, 5.01.517
    Now reviewed for medical necessity, now requires prior authorization

    Q5107 - Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg

    Revised codes

    Effective January 1, 2019

    Dopamine Transporter Imaging with Single-Photon Emission Computed Tomography, 6.01.54
    Now reviewed for medical necessity (previously reviewed for investigative), now requires prior authorization

    A9584 - Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 millicuries

    Removed codes

    Effective January 1, 2019

    Adoptive Immunotherapy, 8.01.01
    Code terminated

    Q2040 - Tisagenlecleucel, up to 250 million CAR-positive viable T cells, including leukapheresis and dose preparation procedures, per infusion

    Amniotic Membrane and Amniotic Fluid, 7.01.149
    Code terminated

    Q4131 - EpiFix or Epicord, per sq cm

    Axial Lumbosacral Interbody Fusion, 7.01.130
    Code terminated

    0195T - Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation, with image guidance, includes bone graft when performed; L5-S1 interspace

    0196T - Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation, with image guidance, includes bone graft when performed; L4-L5 interspace (List separately in addition to code for primary procedure)

    Bioengineered Skin and Soft Tissue Substitutes, 7.01.113
    Code terminated

    Q4172 - PuraPly or PuraPly AM, per sq cm

    Hemlibra® (emicizumab-kxwh), 5.01.581
    Code terminated

    Q9995 - Injection, emicizumab-kxwh, 0.5 mg

    Home Enteral Nutrition, 8.01.502
    Code terminated

    Q9994 - In-line cartridge containing digestive enzyme(s) for enteral feeding, each

    Non-covered Services and Procedures, 10.01.517
    Code terminated

    0360T - Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 30 minutes of technician time, face-to-face with the patient

    0361T - Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; each additional 30 minutes of technician time, face-to-face with the patient (List separately in addition to code for primary service)

    0366T - Group adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients; first 30 minutes of technician time

    0367T - Group adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients; each additional 30 minutes of technician time (List separately in addition to code for primary procedure)

    99090 - Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data)

    Rituxan (rituximab): Non-oncologic and Miscellaneous Uses, 5.01.556
    Code terminated

    J9310 - Injection, rituximab, 100 mg

    Effective January 4, 2019

    Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy), 12.04.141
    No longer reviewed for investigative

    86152 - Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood)

    86153 - Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required

    Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management, 12.04.111
    No longer reviewed for investigative

    0053U - Oncology (prostate cancer), Fish analysis of 4 genes (ASAP1, HDAC9, CHD1 and PTEN), needle biopsy specimen, algorithm reported as probability of higher tumor grade

    Urinary Biomarkers for Cancer Screening, Diagnosis, and Surveillance, 2.04.07
    No longer reviewed for investigative

    0002U - Oncology (colorectal), quantitative assessment of three urine metabolites (ascorbic acid, succinic acid and carnitine) by liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring acquisition, algorithm reported as likelihood of adenomatous polyps

    Added codes

    Effective January 1, 2019

    Codes will now be reviewed by AIM Specialty Health, now requires prior authorization

    77046 - Magnetic resonance imaging, breast, without contrast material; unilateral

    77047 - Magnetic resonance imaging, breast, without contrast material; bilateral

    77048 - Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (cad real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral

    77049 - Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (cad real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral

    76391 - Magnetic resonance (eg, vibration) elastography

    Removed codes

    Effective January 1, 2019

    Codes will no longer be reviewed by AIM Specialty Health

    77058 - Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral

    77059 - Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral

    Revised codes

    Effective January 4, 2019

    Codes will now be reviewed by AIM Specialty Health, now requires prior authorization

    81120 - IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (eg, glioma), common variants (eg, R132H, R132C)

    81121 - IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (eg, glioma), common variants (eg, R140W, R172M)

    81161 - DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis, and duplication analysis, if performed

    81162 - BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements)

    81163 - BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis

    81164 - BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)

    81165 - BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis

    81166 - BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)

    81167 - BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)

    81170 - ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain

    81171 - AFF2 (AF4/FMR2 family, member 2 [FMR2]) (eg, fragile X mental retardation 2 [FRAXE]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles

    81172 - AFF2 (AF4/FMR2 family, member 2 [FMR2]) (eg, fragile X mental retardation 2 [FRAXE]) gene analysis; characterization of alleles (eg, expanded size and methylation status)

    81173 - AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; full gene sequence

    81174 - AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; known familial variant

    81175 - ASXL1 (additional sex combs like 1, transcriptional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; full gene sequence

    81176 - ASXL1 (additional sex combs like 1, transcriptional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; targeted sequence analysis (eg, exon 12)

    81177 - ATN1 (atrophin 1) (eg, dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81178 - ATXN1 (ataxin 1) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81179 - ATXN2 (ataxin 2) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81180 - ATXN3 (ataxin 3) (eg, spinocerebellar ataxia, Machado-Joseph disease) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81181 - ATXN7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81182 - ATXN8OS (ATXN8 opposite strand [non-protein coding]) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81183 - ATXN10 (ataxin 10) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81184 - CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; evaluation to detect abnormal (eg, expanded) alleles

    81185 - CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; full gene sequence

    81186 - CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; known familial variant

    81187 - CNBP (CCHC-type zinc finger nucleic acid binding protein) (eg, myotonic dystrophy type 2) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81188 - CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles

    81189 - CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; full gene sequence

    81190 - CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; known familial variant(s)

    81200 - ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg, E285A, Y231X)

    81201 - APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence

    81202 - APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; known familial variants

    81203 - APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion variants

    81204 - AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; characterization of alleles (eg, expanded size or methylation status)

    81205 - BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (eg, maple syrup urine disease) gene analysis, common variants (eg, R183P, G278S, E422X)

    81206 - BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative

    81207 - BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative

    81208 - BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; other breakpoint, qualitative or quantitative

    81209 - BLM (Bloom syndrome, RecQ helicase-like) (eg, Bloom syndrome) gene analysis, 2281del6ins7 variant

    81210 - BRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, V600 variant(s)

    81211 - BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 del 510bp, exon 8-9 del 7.1kb)

    81212 - BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; 185DELAG, 5385INSC, 6174DELT variants

    81213 - BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; uncommon duplication/deletion variants

    81214 - BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 del 510bp, exon 8-9 del 7.1kb)

    81215 - BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant

    81216 - BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis

    81217 - BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant

    81218 - CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), gene analysis, full gene sequence

    81219 - CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis, common variants in exon 9

    81220 - CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; common variants (eg, ACMG/ACOG guidelines)

    81221 - CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; known familial variants

    81222 - CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; duplication/deletion variants

    81223 - CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; full gene sequence

    81224 - CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; intron 8 poly-T analysis (eg, male infertility)

    81225 - CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17)

    81226 - CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, *4XN)

    81227 - CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *5, *6)

    81228 - Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number variants (eg, bacterial artificial chromosome [BAC] or oligo-based comparative genomic hybridization [CGH] microarray analysis)

    81229 - Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities

    81230 - CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, drug metabolism), gene analysis, common variant(s) (eg, *2, *22)

    81231 - CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *7)

    81232 - DPYD (dihydropyrimidine dehydrogenase) (eg, 5-fluorouracil/5-FU and capecitabine drug metabolism), gene analysis, common variant(s) (eg, *2A, *4, *5, *6)

    81233 - BTK (Bruton's tyrosine kinase) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, C481S, C481R, C481F)

    81234 - DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; evaluation to detect abnormal (expanded) alleles

    81235 - EGFR (epidermal growth factor receptor) (eg, non-small cell lung cancer) gene analysis, common variants (eg, exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q)

    81236 - EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, myelodysplastic syndrome, myeloproliferative neoplasms) gene analysis, full gene sequence

    81237 - EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, diffuse large B-cell lymphoma) gene analysis, common variant(s) (eg, codon 646)

    81238 - F9 (coagulation factor IX) (eg, hemophilia B), full gene sequence

    81239 - DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; characterization of alleles (eg, expanded size)

    81240 - F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene analysis, 20210G>A variant

    81241 - F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene analysis, Leiden variant

    81242 - FANCC (Fanconi anemia, complementation group C) (eg, Fanconi anemia, type C) gene analysis, common variant (eg, IVS4+4A>T)

    81243 - FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles

    81244 - FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status)

    81245 - FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; internal tandem duplication (ITD) variants (ie, exons 14, 15)

    81246 - FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; tyrosine kinase domain (TKD) variants (eg, D835, I836)

    81247 - G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; common variant(s) (eg, A, A-)

    81248 - G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; known familial variant(s)

    81249 - G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; full gene sequence

    81250 - G6PC (glucose-6-phosphatase, catalytic subunit) (eg, Glycogen storage disease, type 1a, von Gierke disease) gene analysis, common variants (eg, R83C, Q347X)

    81251 - GBA (glucosidase, beta, acid) (eg, Gaucher disease) gene analysis, common variants (eg, N370S, 84GG, L444P, IVS2+1G>A)

    81252 - GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; full gene sequence

    81253 - GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; known familial variants

    81254 - GJB6 (gap junction protein, beta 6, 30kDa, connexin 30) (eg, nonsyndromic hearing loss) gene analysis, common variants (eg, 309kb [del(GJB6-D13S1830)] and 232kb [del(GJB6-D13S1854)])

    81255 - HEXA (hexosaminidase A [alpha polypeptide]) (eg, Tay-Sachs disease) gene analysis, common variants (eg, 1278insTATC, 1421+1G>C, G269S)

    81256 - HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene analysis, common variants (eg, C282Y, H63D)

    81257 - HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring)

    81258 - HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; known familial variant

    81259 - HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; full gene sequence

    81260 - IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase complex-associated protein) (eg, familial dysautonomia) gene analysis, common variants (eg, 2507+6T>C, R696P)

    81261 - IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell), gene rearrangement analysis to detect abnormal clonal population(s); amplified methodology (eg, polymerase chain reaction)

    81262 - IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell), gene rearrangement analysis to detect abnormal clonal population(s); direct probe methodology (eg, Southern blot)

    81263 - IGH@ (Immunoglobulin heavy chain locus) (eg, leukemia and lymphoma, B-cell), variable region somatic mutation analysis

    81264 - IGK@ (Immunoglobulin kappa light chain locus) (eg, leukemia and lymphoma, B-cell), gene rearrangement analysis, evaluation to detect abnormal clonal population(s)

    81265 - Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (eg, pre-transplant recipient and donor germline testing, post-transplant non-hematopoietic recipient germline [eg, buccal swab or other germline tissue sample]

    81266 - Comparative analysis using Short Tandem Repeat (STR) markers; each additional specimen (eg, additional cord blood donor, additional fetal samples from different cultures, or additional zygosity in multiple birth pregnancies) (List separately in addition to code for primary procedure)

    81269 - HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; duplication/deletion variants

    81270 - JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, p.Val617Phe (V617F) variant

    81271 - HTT (huntingtin) (eg, Huntington disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles

    81272 - KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons 8, 11, 13, 17, 18)

    81273 - KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, mastocytosis), gene analysis, D816 variant(s)

    81274 - HTT (huntingtin) (eg, Huntington disease) gene analysis; characterization of alleles (eg, expanded size)

    81275 - KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; variants in exon 2 (eg, codons 12 and 13)

    81276 - KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146)

    81283 - IFNL3 (interferon, lambda 3) (eg, drug response), gene analysis, rs12979860 variant

    81284 - FXN (frataxin) (eg, Friedreich ataxia) gene analysis; evaluation to detect abnormal (expanded) alleles

    81285 - FXN (frataxin) (eg, Friedreich ataxia) gene analysis; characterization of alleles (eg, expanded size)

    81286 - FXN (frataxin) (eg, Friedreich ataxia) gene analysis; full gene sequence

    81287 - MGMT (O-6-methylguanine-DNA methyltransferase) (eg, glioblastoma multiforme) promoter methylation analysis

    81288 - MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis

    81289 - FXN (frataxin) (eg, Friedreich ataxia) gene analysis; known familial variant(s)

    81290 - MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene analysis, common variants (eg, IVS3-2A>G, del6.4kb)

    81291 - MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C)

    81292 - MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis

    81293 - MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants

    81294 - MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis
    colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants

    81295 - MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non-polyposis
    colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis

    81296 - MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non-polyposis
    colorectal cancer, Lynch syndrome) gene analysis; known familial variants

    81297 - MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non-polyposis
    colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants

    81298 - MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis

    81299 - MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants

    81300 - MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants

    81301 - Microsatellite instability analysis (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) of markers for mismatch repair deficiency (eg, BAT25, BAT26), includes comparison of neoplastic and normal tissue, if performed

    81302 - MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; full sequence analysis

    81303 - MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; known familial variant

    81304 - MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; duplication/deletion variants

    81305 - MYD88 (myeloid differentiation primary response 88) (eg, Waldenstrom's macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant

    81306 - NUDT15 (nudix hydrolase 15) (eg, drug metabolism) gene analysis, common variant(s) (eg, *2, *3, *4, *5, *6)

    81310 - NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, exon 12 variants

    81311 - NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61)

    81312 - PABPN1 (poly[A] binding protein nuclear 1) (eg, oculopharyngeal muscular dystrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81313 - PCA3/KLK3 (prostate cancer antigen 3 [non-protein coding]/kallikrein-related peptidase 3 [prostate specific antigen]) ratio (eg, prostate cancer)

    81314 - PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [GIST]), gene analysis, targeted sequence analysis (eg, exons 12, 18)

    81315 - PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; common breakpoints (eg, intron 3 and intron 6), qualitative or quantitative

    81316 - PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; single breakpoint (eg, intron 3, intron 6 or exon 6), qualitative or quantitative

    81317 - PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis

    81318 - PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants

    81319 - PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants

    81320 - PLCG2 (phospholipase C gamma 2) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, R665W, S707F, L845F)

    81321 - PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; full sequence analysis

    81322 - PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; known familial variant

    81323 - PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; duplication/deletion variant

    81324 - PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; duplication/deletion analysis

    81325 - PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; full sequence analysis

    81326 - PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; known familial variant

    81327 - SEPT9 (Septin9) (eg, colorectal cancer) methylation analysis

    81328 - SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (eg, *5)

    81329 - SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; dosage/deletion analysis (eg, carrier testing), includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed

    81330 - SMPD1(sphingomyelin phosphodiesterase 1, acid lysosomal) (eg, Niemann-Pick disease, Type A) gene analysis, common variants (eg, R496L, L302P, fsP330)

    81331 - SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A) (eg, Prader-Willi syndrome and/or Angelman syndrome), methylation analysis

    81332 - SERPINA1 (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin, member 1) (eg, alpha-1-antitrypsin deficiency), gene analysis, common variants (eg, *S and *Z)

    81333 - TGFBI (transforming growth factor beta-induced) (eg, corneal dystrophy) gene analysis, common variants (eg, R124H, R124C, R124L, R555W, R555Q)

    81334 - RUNX1 (runt related transcription factor 1) (eg, acute myeloid leukemia, familial platelet disorder with associated myeloid malignancy), gene analysis, targeted sequence analysis (eg, exons 3-8)

    81335 - TPMT (thiopurine S-methyltransferase) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3)

    81336 - SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; full gene sequence

    81337 - SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; known familial sequence variant(s)

    81340 - TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using amplification methodology (eg, polymerase chain reaction)

    81341 - TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using direct probe methodology (eg, Southern blot)

    81342 - TRG@ (T cell antigen receptor, gamma) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population(s)

    81343 - PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81344 - TBP (TATA box binding protein) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles

    81345 - TERT (telomerase reverse transcriptase) (eg, thyroid carcinoma, glioblastoma multiforme) gene analysis, targeted sequence analysis (eg, promoter region)

    81346 - TYMS (thymidylate synthetase) (eg, 5-fluorouracil/5-FU drug metabolism), gene analysis, common variant(s) (eg, tandem repeat variant)

    81350 - UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, irinotecan metabolism), gene analysis, common variants (eg, *28, *36, *37)

    81355 - VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) (eg, -1639G>A, c.173+1000C>T)

    81361 - HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE)

    81362 - HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); known familial variant(s)

    81363 - HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); duplication/deletion variant(s)

    81364 - HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); full gene sequence

    81400 - Molecular pathology procedure, Level 1(eg, identification of single germline variant [eg, SNP] by techniques such as restriction enzyme digestion or melt curve analysis)

    81401 - Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated variant, or 1 somatic variant [typically using non-sequencing target variant analysis], or detection of a dynamic mutation disorder/triplet repeat)

    81402 - Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2-10 methylated variants, or 2-10 somatic variants [typically using non-sequencing target variant analysis], immunoglobulin and T-cell receptor gene rearrangements, duplication/deletion variants of 1 exon, loss of heterozygosity [LOH], uniparental disomy [UPD])

    81403 - Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons)

    81404 - Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis)

    81405 - Molecular pathology procedure, Level 6 (eg, analysis of 6-10 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 11-25 exons, regionally targeted cytogenomic array analysis)

    81406 - Molecular pathology procedure, Level 7 (eg, analysis of 11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons, cytogenomic array analysis for neoplasia)

    81407 - Molecular pathology procedure, Level 8 (eg, analysis of 26-50 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of >50 exons, sequence analysis of multiple genes on one platform)

    81408 - Molecular pathology procedure, Level 9 (eg, analysis of >50 exons in a single gene by DNA sequence analysis)

    81410 - Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK

    81411 - Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1

    81412 - Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1

    81413 - Cardiac ion channelopathies (eg, Brugada syndrome, long QT syndrome, catecholaminergic polymorphic ventricular tachycardia); genomic sequence analysis panel, must include sequencing of at least 10 genes, including ANK2, CASQ2, CAV3, KCNE1, KCNE2, KCNH2, KCNJ2, KCNQ1, RYR2, and SCN5A

    81414 - Cardiac ion channelopathies (eg, Brugada syndrome, long QT syndrome, catecholaminergic polymorphic ventricular tachycardia); duplication/deletion gene analysis panel, must include analysis of at least 2 genes, including KCNH2 and KCNQ1

    81415 - Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis

    81416 - Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (eg, parents, siblings) (List separately in addition to code for primary procedure)

    81417 - Exome (eg, unexplained constitutional or heritable disorder or syndrome); re-evaluation of previously obtained exome sequence (eg, updated knowledge or unrelated condition/syndrome)

    81420 - Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21

    81422 - Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood

    81425 - Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis

    81426 - Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genome (eg, parents, siblings) (List separately in addition to code for primary procedure)

    81427 - Genome (eg, unexplained constitutional or heritable disorder or syndrome); re-evaluation of previously obtained genome sequence (eg, updated knowledge or unrelated condition/syndrome)

    81430 - Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); genomic sequence analysis panel, must include sequencing of at least 60 genes, including CDH23, CLRN1, GJB2, GPR98, MTRNR1, MYO7A, MYO15A, PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3, USH1C, USH1G, USH2A, and WFS1

    81431 - Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); duplication/deletion analysis panel, must include copy number analyses for STRC and DFNB1 deletions in GJB2 and GJB6 genes

    81432 - Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least 10 genes, always including BRCA1, BRCA2, CDH1, MLH1, MSH2, MSH6, PALB2, PTEN, STK11, and TP53

    81433 - Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11

    81434 - Hereditary retinal disorders (eg, retinitis pigmentosa, Leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes, including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO, RP1, RP2, RPE65, RPGR, and USH2A

    81435 - Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include sequencing of at least 10 genes, including APC, BMPR1A, CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4, and STK11

    81436 - Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); duplication/deletion analysis panel, must include analysis of at least 5 genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11

    81437 - Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); genomic sequence analysis panel, must include sequencing of at least 6 genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL

    81438 - Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); duplication/deletion analysis panel, must include analyses for SDHB, SDHC, SDHD, and VHL

    81439 - Hereditary cardiomyopathy (eg, hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy), genomic sequence analysis panel, must include sequencing of at least 5 cardiomyopathy-related genes (eg, DSG2, MYBPC3, MYH7, PKP2, TTN)

    81440 - Nuclear encoded mitochondrial genes (eg, neurologic or myopathic phenotypes), genomic sequence panel, must include analysis of at least 100 genes, including BCS1L, C10orf2, COQ2, COX10, DGUOK, MPV17, OPA1, PDSS2, POLG, POLG2, RRM2B, SCO1, SCO2, SLC25A4, SUCLA2, SUCLG1, TAZ, TK2, and TYMP

    81442 - Noonan spectrum disorders (eg, Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence analysis panel, must include sequencing of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1

    81443 - Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish-associated disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH)

    81445 - Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, and RNA analysis when performed, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, NRAS, MET, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed

    81448 - Hereditary peripheral neuropathies (eg, Charcot-Marie-Tooth, spastic paraplegia), genomic sequence analysis panel, must include sequencing of at least 5 peripheral neuropathy-related genes (eg, BSCL2, GJB1, MFN2, MPZ, REEP1, SPAST, SPG11, SPTLC1)

    81450 - Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA analysis, and RNA analysis when performed, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KRAS, KIT, MLL, NRAS, NPM1, NOTCH1), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed

    81455 - Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA analysis, and RNA analysis when performed, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NPM1, NRAS, MET, NOTCH1, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed

    81460 - Whole mitochondrial genome (eg, Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes [MELAS], myoclonic epilepsy with ragged-red fibers [MERFF], neuropathy, ataxia, and retinitis pigmentosa [NARP], Leber hereditary op

    81465 - Whole mitochondrial genome large deletion analysis panel (eg, Kearns-Sayre syndrome, chronic progressive external ophthalmoplegia), including heteroplasmy detection, if performed

    81470 - X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID); genomic sequence analysis panel, must include sequencing of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and SLC16A2

    81471 - X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID); duplication/deletion gene analysis, must include analysis of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and SLC16A2

    81479 - Unlisted molecular pathology procedure

    81493 - Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score

    81504 - Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores

    81507 - Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy

    81518 - Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy

    81519 - Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score

    81520 - Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 content and 8 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence risk score

    81521 - Oncology (breast), mRNA, microarray gene expression profiling of 70 content genes and 465 housekeeping genes, utilizing fresh frozen or formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk of distant metastasis

    81525 - Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score

    81540 - Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported

    81541 - Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a disease-specific mortality risk score

    81545 - Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious)

    81551 - Oncology (prostate), promoter methylation profiling by real-time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a likelihood of prostate cancer detection on repeat biopsy

    81595 - Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score

    0001U - Red blood cell antigen typing, DNA, human erythrocyte antigen gene analysis of 35 antigens from 11 blood groups, utilizing whole blood, common RBC alleles reported

    0004M - Scoliosis, DNA analysis of 53 single nucleotide polymorphisms (SNPs), using saliva, prognostic algorithm reported as a risk score

    0005U - Oncology (prostate) gene expression profile by real-time RT-PCR of 3 genes (ERG, PCA3, and SPDEF), urine, algorithm reported as risk score

    0006M - Oncology (hepatic), mRNA expression levels of 161 genes, utilizing fresh hepatocellular carcinoma tumor tissue, with alpha-fetoprotein level, algorithm reported as a risk classifier

    0007M - Oncology (gastrointestinal neuroendocrine tumors), real-time PCR expression analysis of 51 genes, utilizing whole peripheral blood, algorithm reported as a nomogram of tumor disease index

    0009M - Fetal aneuploidy (trisomy 21, and 18) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy

    0011M - Oncology, prostate cancer, mRNA expression assay of 12 genes (10 content and 2 housekeeping), RT-PCR test utilizing blood plasma and/or urine, algorithms to predict high-grade prostate cancer risk

    0012M - Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative PCR of five genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and XCR2), utilizing urine, algorithm reported as a risk score for having urothelial carcinoma

    0012U - Germline disorders, gene rearrangement detection by whole genome next-generation sequencing, DNA, whole blood, report of specific gene rearrangement(s)

    0013M - Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative PCR of five genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and CXCR2), utilizing urine, algorithm reported as a risk score for having recurrent urothelial carcinoma

    0013U - Oncology (solid organ neoplasia), gene rearrangement detection by whole genome next-generation sequencing, DNA, fresh or frozen tissue or cells, report of specific gene rearrangement(s)

    0014U - Hematology (hematolymphoid neoplasia), gene rearrangement detection by whole genome next generation sequencing, DNA, whole blood or bone marrow, report of specific gene rearrangement(s)

    0016U - Oncology (hematolymphoid neoplasia), RNA, BCR/ABL1 major and minor breakpoint fusion transcripts, quantitative PCR amplification, blood or bone marrow, report of fusion not detected or detected with quantitation

    0017U - Oncology (hematolymphoid neoplasia), JAK2 mutation, DNA, PCR amplification of exons 12-14 and sequence analysis, blood or bone marrow, report of JAK2 mutation not detected or detected

    0018U - Oncology (thyroid), microRNA profiling by RT-PCR of 10 microRNA sequences, utilizing fine needle aspirate, algorithm reported as a positive or negative result for moderate to high risk of malignancy

    0019U - Oncology, RNA, gene expression by whole transcriptome sequencing, formalin-fixed paraffin embedded tissue or fresh frozen tissue, predictive algorithm reported as potential targets for therapeutic agents

    0022U - Targeted genomic sequence analysis panel, non-small cell lung neoplasia, DNA and RNA analysis, 23 genes, interrogation for sequence variants and rearrangements, reported as presence/absence of variants and associated therapy(ies) to consider

    0023U - Oncology (acute myelogenous leukemia), DNA, genotyping of internal tandem duplication, p.D835, p.I836, using mononuclear cells, reported as detection or non-detection of FLT3 mutation and indication for or against the use of midostaurin

    0026U - Oncology (thyroid), DNA and mRNA of 112 genes, next-generation sequencing, fine needle aspirate of thyroid nodule, algorithmic analysis reported as a categorical result ("Positive, high probability of malignancy" or "Negative, low probability of malignancy")

    0027U - JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, targeted sequence analysis exons 12-15

    0028U - CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, copy number variants, common variants with reflex to targeted sequence analysis

    0029U - Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis (ie, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, SLCO1B1, VKORC1 and rs12777823)

    0030U - Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823)

    0031U - CYP1A2 (cytochrome P450 family 1, subfamily A, member 2) (eg, drug metabolism) gene analysis, common variants (ie, *1F, *1K, *6, *7)

    0032U - COMT (catechol-O-methyltransferase) (drug metabolism) gene analysis, c.472G>A (rs4680) variant

    0033U - HTR2A (5-hydroxytryptamine receptor 2A), HTR2C (5-hydroxytryptamine receptor 2C) (eg, citalopram metabolism) gene analysis, common variants (ie, HTR2A rs7997012 [c.614-2211T>C], HTR2C rs3813929 [c.- 759C>T] and rs1414334 [c.551-3008C>G])

    0034U - TPMT (thiopurine S-methyltransferase), NUDT15 (nudix hydroxylase 15) (eg, thiopurine metabolism), gene analysis, common variants (ie, TPMT *2, *3A, *3B, *3C, *4, *5, *6, *8, *12; NUDT15 *3, *4, *5)

    0036U - Exome (ie, somatic mutations), paired formalin-fixed paraffin-embedded tumor tissue and normal specimen, sequence analyses

    0037U - Targeted genomic sequence analysis, solid organ neoplasm, DNA analysis of 324 genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability and tumor mutational burden

    0040U - BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis, major breakpoint, quantitative

    0045U - Oncology (breast ductal carcinoma in situ), mRNA, gene expression profiling by realtime RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence score

    0046U - FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia) internal tandem duplication (ITD) variants, quantitative

    0047U - Oncology (prostate), mRNA, gene expression profiling by real-time RT-PCR of 17 genes (12 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a risk score

    0048U - Oncology (solid organ neoplasia), DNA, targeted sequencing of protein-coding exons of 468 cancer-associated genes, including interrogation for somatic mutations and microsatellite instability, matched with normal specimens, utilizing formalin-fixed paraffin-embedded tumor tissue, report of clinically significant mutation(s)

    0049U - NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, quantitative

    0050U - Targeted genomic sequence analysis panel, acute myelogenous leukemia, DNA analysis, 194 genes, interrogation for sequence variants, copy number variants or rearrangements

    0055U - Cardiology (heart transplant), cell-free DNA, PCR assay of 96 DNA target sequences (94 single nucleotide polymorphism targets and two control targets), plasma

    0056U - Hematology (acute myelogenous leukemia), DNA, whole genome next generation sequencing to detect gene rearrangement(s), blood or bone marrow, report of specific gene rearrangement(s)

    0057U - Oncology (solid organ neoplasia), mRNA, gene expression profiling by massively parallel sequencing for analysis of 51 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as a normalized percentile rank

    0060U - Twin zygosity, genomic targeted sequence analysis of chromosome 2, using circulating cell-free fetal DNA in maternal blood

    0069U - Oncology (colorectal), microRNA, RT-PCR expression profiling of miR-31-3p, formalin-fixed paraffin-embedded tissue, algorithm reported as an expression score

    0070U - CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, common and select rare variants (ie, *2, *3, *4, *4N, *5, *6, *7, *8, *9, *10, *11, *12, *13, *14A, *14B, *15, *17, *29, *35, *36, *41, *57, *61, *63, *68, *83, *xN)

    0071U - CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, full gene sequence (List separately in addition to code for primary procedure)

    0072U - CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, CYP2D6-2D7 hybrid gene) (List separately in addition to code for primary procedure)

    0073U - CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, CYP2D7-2D6 hybrid gene) (List separately in addition to code for primary procedure)

    0074U - CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, non-duplicated gene when duplication/multiplication is trans) (List separately in addition to code for primary procedure)

    0075U - CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, 5’ gene duplication/multiplication) (List separately in addition to code for primary procedure)

    0076U - CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, 3’ gene duplication/ multiplication) (List separately in addition to code for primary procedure)

    0078U - Pain management (opioid-use disorder) genotyping panel, 16 common variants (ie, ABCB1, COMT, DAT1, DBH, DOR, DRD1, DRD2, DRD4, GABA, GAL, HTR2A, HTTLPR, MTHFR, MUOR, OPRK1, OPRM1), buccal swab or other germline tissue sample, algorithm reported as positive or negative risk of opioid-use disorder

    0079U - Comparative DNA analysis using multiple selected single-nucleotide polymorphisms (SNPs), urine and buccal DNA, for specimen identity verification

    0081U - Oncology (uveal melanoma), mRNA, gene-expression profiling by real-time RT-PCR of 15 genes (12 content and 3 housekeeping genes), utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue, algorithm reported as risk of metastasis

    G0452 - Molecular pathology procedure; physician interpretation and report

    G9143 - Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)

    S3620 - Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; phenylalanine (PKU); and thyroxine, total)

    S3800 - Genetic testing for amyotrophic lateral sclerosis (ALS)

    S3840 - DNA analysis for germline mutations of the RET proto-oncogene for susceptibility to multiple endocrine neoplasia type 2

    S3841 - Genetic testing for retinoblastoma

    S3842 - Genetic testing for Von Hippel-Lindau disease

    S3844 - DNA analysis of the connexin 26 gene (GJB2) for susceptibility to congenital, profound deafness

    S3845 - Genetic testing for alpha-thalassemia

    S3846 - Genetic testing for hemoglobin E beta-thalassemia

    S3849 - Genetic testing for Niemann-Pick disease

    S3850 - Genetic testing for sickle cell anemia

    S3852 - DNA analysis for APOE epsilon 4 allele for susceptibility to Alzheimer's disease

    S3853 - Genetic testing for myotonic muscular dystrophy

    S3854 - Gene expression profiling panel for use in the management of breast cancer treatment

    S3861 - Genetic testing, sodium channel, voltage-gated, type V, alpha subunit (SCN5A) and variants for suspected Brugada Syndrome

    S3865 - Comprehensive gene sequence analysis for hypertrophic cardiomyopathy

    S3866 - Genetic analysis for a specific gene mutation for hypertrophic cardiomyopathy (HCM) in an individual with a known HCM mutation in the family

    S3870 - Comparative genomic hybridization (CGH) microarray testing for developmental delay, autism spectrum disorder and/or intellectual disability

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