Persius/hicric huggingface dataset:
Billing and Coding: MolDX: Fragile X

The MolDX Team has determined that Fragile X testing is not a Medicare covered
service. Screening in the absence of signs and symptoms of an illness or
injury is not defined as a Medicare benefit. Therefore, MolDX will deny
testing for Fragile X as a statutorily excluded service.  
  
To receive a Fragile X service denial, please submit the following claim
information:

  * Select the appropriate CPT code: 
    * 81243- FMR1
    * 81244- FMR1, methylation analysis
    * 81470 - X-linked intellectual disability genomic sequence analysis panel
    * 81471 - X-linked intellectual disability genomic sequence analysis panel duplication / deletion
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.
  * For a voluntary issued ABN, append with GX modifier
  * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier

For CPT non-NOC codes, Labs may either use the SV101-7 or SV202-7 (preferred)
or the NTE field to submit this required information.

  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form

NOTE: When entering the DEX Z-Code on the SV101-7 documentation field for
Part B claims please do not add additional characters or information on the
line.
Billing and Coding: MolDX: GBA Genetic Testing

Mutations found in glucosidase, beta, acid (GBA) are associated with Gaucher
disease (GD), which encompasses a continuum of clinical findings. Since GBA
genetic testing is used to confirm the clinical findings to diagnose GD, the
MolDX Team has determined that GBA genetic testing is not a Medicare benefit
and is a statutorily excluded service. In addition to single gene testing,
MolDX will also deny panels of tests that include the GBA gene as a
statutorily excluded service.  
  
To receive a GBA test denial, please submit the following claim information:

  * CPT code 81251- GBA, common variants
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services 
    * For a voluntary issued ABN, append with GX HCPCS modifier
    * To indicate a statutorily excluded service, append with a GY HCPCS modifier
  * For CPT non-NOC codes, Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information. 
    * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
      * Loop 2400 or SV101-7 for the 5010A1 837P
      * Item 19 for paper claim
    * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
      * Line SV202-7 for 837I electronic claim
      * Block 80 for the UB04 claim form
Billing and Coding: MolDX: HAX1 Gene Sequencing

HAX1 gene sequencing may be performed during the diagnosis of HAX1-related
Congentital Neutropenia (CN) and Kostmann disease. A HAX1 mutation will only
provide reproductive risk stratification for CN. In individuals with Kostmann
syndrome, a HAX1 mutation will not change the medical management. Therefore,
the MolDX Contractor has determined HAX1 gene sequencing is a statutorily
excluded test. In addition to single gene testing, MolDX will also deny panels
of tests that include the HAX1 gene.  
  
To receive a HAX1 gene sequencing service denial, please submit the following
claim information:

  * CPT code 81479
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.  

    * For a voluntary issued ABN, append with GX modifier
    * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
  * For CPT non-NOC codes, Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information. 
    * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
      * Loop 2400 or SV101-7 for the 5010A1 837P
      * Item 19 for paper claim
    * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
      * Line SV202-7 for 837I electronic claim
      * Block 80 for the UB04 claim form
Billing and Coding: MolDX: HBB Gene Tests

HBB gene testing may be performed during the diagnosis of Sickle cell disease
(SCD). Since clinical symptoms and diagnosis usually occur prior to Medicare
eligibility and carrier testing is not a covered benefit, the MolDX Team has
determined HBB gene testing is a statutorily excluded service. MolDX will also
deny panels of tests that include the HBB gene.  
  
To receive a HBB gene sequencing service denial, please submit the following
claim information:

  * Select the appropriate CPT code based on gene test 
    * 81361 - HBB, common variants
    * 81362 - HBB, known familiar variants
    * 81363 - HBB, duplication/deletion
    * 81364 - HBB, full gene sequence
    * 81443 - Genetic testing for severe inherited conditions
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
Billing and Coding: MolDX: HBB Gene Tests

HBB gene testing may be performed during the diagnosis of Sickle cell disease
(SCD). Since clinical symptoms and diagnosis usually occur prior to Medicare
eligibility and carrier testing is not a covered benefit, the MolDX Team has
determined HBB gene testing is a statutorily excluded service. MolDX will also
deny panels of tests that include the HBB gene.  
  
To receive a HBB gene sequencing service denial, please submit the following
claim information:

  * Select the appropriate CPT code based on gene test:
  *     * 81361 - HBB, common variants
    * 81362 - HBB, known familiar variants
    * 81363 - HBB, duplication/deletion
    * 81364 - HBB, full gene sequence
    * 81443 - Genetic testing for severe inherited condition
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services 
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
Billing and Coding: MolDX: HEXA Gene Analysis

The clinical diagnosis of Hexosaminidase A deficiency, a disorder also known
as Tay-Sachs disease characterized by progressive weakness, loss of motor
skills, and increased startle reflex in infants, relies on blood tests that
result in absent or near absent beta-hexosaminidase A (HEX A) enzymatic
activity. Molecular genetic testing identifies HEXA gene mutation carriers at
risk for conceiving offspring with the disease. Therefore, HEXA genetic
testing is not a Medicare benefit and is a statutorily excluded service. In
addition to single gene testing, the MolDX Contractor will also deny panels of
tests that include the HEXA gene as a statutorily excluded service.  
  
To receive a HEXA gene test service denial, please submit the following claim
information:

  *     * Select the appropriate CPT code based on type of testing 
      * 81255 - HEXA, common variants
      * 81406 - HEXA, full gene sequence
      * 81412 - Ashkenazi Jewish associated disorders
      * 81443 - Genetic testing for severe inherited conditions
    * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.  

      * For a voluntary issued ABN, append with GX modifier
      * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
    * Enter the DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following claim field/types:  

      * Loop 2400 or SV101-7 for the 5010A1 837P
      * Item 19 for paper claim
    * Enter the DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
      * Line SV202-7 for 837I electronic claim
      * Block 80 for the UB04 claim form
Billing and Coding: MolDX: HEXA Gene Analysis

The clinical diagnosis of Hexosaminidase A deficiency, a disorder also known
as Tay-Sachs disease characterized by progressive weakness, loss of motor
skills, and increased startle reflex in infants, relies on blood tests that
result in absent or near absent beta-hexosaminidase A (HEX A) enzymatic
activity. Molecular genetic testing identifies HEXA gene mutation carriers at
risk for conceiving offspring with the disease. Therefore, HEXA genetic
testing is not a Medicare benefit and is a statutorily excluded service. In
addition to single gene testing, the MolDX Contractor will also deny panels of
tests that include the HEXA gene as a statutorily excluded service.

To receive a HEXA gene test service denial, please submit the following claim
information:

  *     * Select the appropriate CPT code based on type of testing 
      * 81255 - HEXA, common variants
      * 81406 - HEXA, full gene sequence
      * 81412 - Ashkenazi Jewish associated disorders
      * 81443 - Genetic testing for severe inherited conditions
    * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services. 
      * For a voluntary issued ABN, append with GX modifier
      * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
    * Enter the DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
      * Loop 2400 or SV101-7 for the 5010A1 837P
      * Item 19 for paper claim
    * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
      * Line SV202-7 for 837I electronic claim
      * Block 80 for the UB04 claim form
Response to Comments: Cataract Extraction As an important part of Medicare
Local Coverage Determination (LCD) development, National Government Services
solicits comments from the provider community and from members of the public
who may be affected by or interested in our LCDs. The purpose of the advice
and comment process is to gain the expertise and experience of those
commenting.  
  
National Government Services thanks those who reviewed our draft LCD on
Cataract Extraction during the June 30, 2016 through August 13, 2016 Comment
Period. The Notice Period began on September 16, 2016, and will end on October
31, 2016. The final LCD will become effective for services rendered on or
after November 1, 2016.
Response to Comments: Implantable Miniature Telescope (IMT) As an important
part of Medicare Local Coverage Determination (LCD) development, National
Government Services solicits comments from the provider community and from
members of the public who may be affected by or interested in our LCDs. The
purpose of the advice and comment process is to gain the expertise and
experience of those commenting.  
  
We would like to thank those who suggested changes to the LCD for Implantable
Miniature Telescope (IMT). The official notice period for the final LCD begins
on September 16, 2016 and the final determination will become effective on
November 1, 2016.
Billing and Coding: MolDX: HTTLPR Gene Testing

Serotonin Transporter genotyping (HTTLPR) has been associated with response to
selective serotonin reuptake inhibitors. However since the literature is
conflicting and limited by small sample sizes, the MolDX Team has determined
there is insufficient evidence to support coverage. Therefore, HTTLPR testing
is a statutorily excluded service.

To receive a HTTLPR analysis service denial, please submit the following claim
information:

  * CPT code 81479
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
Billing and Coding: MolDX: HTTLPR Gene Testing

Serotonin Transporter genotyping (HTTLPR) has been associated with response to
selective serotonin reuptake inhibitors. However since the literature is
conflicting and limited by small sample sizes, the MolDX Team has determined
there is insufficient evidence to support coverage. Therefore, HTTLPR testing
is a statutorily excluded service.  
  
To receive a HTTLPR analysis service denial, please submit the following claim
information:

  * CPT code 81479
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
Billing and Coding: MolDX: KIF6 Genotype

The MolDX Team has completed a review on the KIF6 genotype test. To date,
there is insufficient evidence to support the required clinical utility for
the established Medicare benefit category. Therefore, the KIF6 genotype test
is a statutorily excluded test.  
  
To receive a KIF6 service denial, please submit the following claim
information:

  * CPT code 81479 -Unlisted molecular pathology procedure
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
Billing and Coding: MolDX: KIF6 Genotype

The MolDX Team has completed a review on the KIF6 genotype test. To date,
there is insufficient evidence to support the required clinical utility for
the established Medicare benefit category. Therefore, the KIF6 genotype test
is a statutorily excluded test.  
  
To receive a KIF6 service denial, please submit the following claim
information:

  * CPT code 81479 - Unlisted molecular pathology procedure
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
Billing and Coding: MolDX: Know error

The know error DNA Specimen Provenance Assay is a forensic assay to confirm
that a surgical specimen belongs to the patient evaluated for treatment.
Although MolDX agrees the healthcare community should define and follow strict
procedures regarding patient and patient specimen identification and handling,
tests performed to measure the quality of a process do not provide information
to diagnose or treat a patient illness or injury as defined in the Medicare
benefit category. Therefore, the know error DNA Specimen Provenance Assay is
a statutorily excluded test. Although an Advance Beneficiary Notice (ABN) is
not required for a statutory exclusion, providers supplying this test
(directly or through a purchased service) should ensure patients understand
the test is not a covered benefit.  
  
To receive a DNA Specimen Provenance Assay service denial, please submit the
following claim information:

  * CPT code 84999 - unlisted chemistry procedure 
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier. An Advance Beneficiary Notice (ABN) is not required for statutorily excluded service
  * Select the appropriate diagnosis for the patient

If you believe your practice has submitted claims and received reimbursement
in error, you may take the following corrective actions:

  * Complete a Self-Audit
    * identify incorrect submissions
    * contain further claim submission errors
  * Consider Self-Disclosure Protocol
    * self-disclosure guidelines available @ the following pathway: http://www.oig.hhs.gov/compliance/self-disclosure-info/index.asp
Billing and Coding: MolDX: Know error

The Know error DNA Specimen Provenance Assay is a forensic assay to confirm
that a surgical specimen belongs to the patient evaluated for treatment.
Although MolDX agrees the healthcare community should define and follow strict
procedures regarding patient and patient specimen identification and handling,
tests performed to measure the quality of a process do not provide information
to diagnose or treat a patient illness or injury as defined in the Medicare
benefit category. Therefore, the know error DNA Specimen Provenance Assay is
a statutorily excluded test. Although an Advance Beneficiary Notice (ABN) is
not required for a statutory exclusion, providers supplying this test
(directly or through a purchased service) should ensure patients understand
the test is not a covered benefit.  
  
To receive a DNA Specimen Provenance Assay service denial, please submit the
following claim information:

  * CPT code 84999 - unlisted chemistry procedure 
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier. An Advance Beneficiary Notice (ABN) is not required for statutorily excluded service
  * Select the appropriate diagnosis for the patient

If you believe your practice has submitted claims and received reimbursement
in error, you may take the following corrective actions:

  * Complete a Self-Audit
    * identify incorrect submissions
    * contain further claim submission errors
  * Consider Self-Disclosure Protocol
    * self-disclosure guidelines available @ the following pathway: http://www.oig.hhs.gov/compliance/self-disclosure-info/index.asp
Response to Comments: Wound Application of Cellular and/or Tissue Based
products (CTPs), Lower Extremities The following are comments received by CGS
Administrators during the comment period for the draft policy Application of
skin substitutes for Wounds, Lower Extremities DL36690 and their responses.
Based on a comment received the title of the final was changed from the draft
title.
Billing and Coding: MolDX: L1CAM Gene Sequencing

L1 syndrome refers to multiple disorders including X-linked hydrocephalus with
aqueduct of Sylvius (HSAS) stenosis, MASA syndrome (Mental retardation,
Aphasia, Spastic paraplegia, Adducted thumbs), SPG1 (X-linked complicated
hereditary spastic paraplegia type 1), and X-linked complicated corpus
callosum agenesis. Because there are many potential underlying causes for
congenital hydrocephalus, including syndromic and nonsyndromic cases,
recurrence risk and implications for family members is based upon underlying
etiology. Genetic testing of the L1CAM gene is used to confirm a clinical
diagnosis and provide recurrence risk. Therefore, the MolDX Contractor has
determined L1CAM full gene sequencing is a statutorily excluded test.  
  
To receive a L1CAM gene sequencing service denial, please submit the following
claim information:

  * CPT code 81407-L1CAM
  * CPT code 81470- X-linked intellectual disability genomic sequence analysis panel
  * CPT code 81471- X-linked intellectual disability genomic sequence analysis panel duplication / deletion 
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier. An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
Billing and Coding: MolDX: LPA-Aspirin Genotype

The MolDX Contractor has completed a review of the research on the LPA-Aspirin
genotype test, developed to predict increased CVD risk and event reduction
during aspirin therapy. To date, there is insufficient evidence to support the
required clinical utility for the established Medicare benefit category.
Therefore, the LPA-Aspirin genotype test is a statutorily excluded test.  
  
As reviewed, the developer described the indication to perform a LPA-Aspirin
genotype test as a risk assessment for developing a disease or condition. Risk
assessment for developing a disease or condition in the absence of signs and
symptoms of an illness or injury is also not defined as a Medicare benefit.
Therefore, the LPA-Aspirin genotype test would continue to be a statutory
excluded test.  
  
To receive a LPA-Aspirin service denial, please submit the following claim
information:

  * CPT code 81479 -Unlisted molecular pathology procedure
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services 
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier
  * Enter the appropriate DEX Z-CodeTM Identifier adjacent to the CPT code for the test in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM Identifier adjacent to the CPT code for the test in the comment/narrative field for the following Part A claim field/types:
  *     * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form