Persius/hicric huggingface dataset:
Billing and Coding: MolDX: ATP7B Gene Tests

Effective for dates of service on and after July 24, 2013  
  
ATP7B gene mutations have been primarily associated with Wilson Disease, a
disorder of copper metabolism. However, serology remains the gold standard for
testing and treating the signs and symptoms of this condition. At present the
literature does not support that ATP7B gene testing changes physician
treatment or improves patient outcomes. Therefore, the MolDX Team has
determined ATP7B gene testing is a statutorily excluded service. MolDX will
also deny panels of tests that include the ATP7B gene.  
  
To receive an ATP7B gene test denial, please submit the following claim
information:

    * Select the appropriate CPT code for the performed service:  

      * 81406 - ATP7B, fgs
      * 81443 - Genetic Testing for severe genetic conditions
      * 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 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
      * Box 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: PIK3CA Gene Tests

Effective for dates of service on and after May 24, 2019.

The U.S. Food and Drug Administration (FDA) has approved Piqray (alpelisib)
tablets, to be used in combination with the (FDA)-approved endocrine therapy
fulvestrant, to treat postmenopausal women, and men, with hormone receptor
(HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative,
PIK3CA-mutated, advanced or metastatic breast cancer (as detected by an FDA-
approved test) following progression on or after an endocrine-based regimen.  
  
To submit a claim for PIK3CA targeted gene sequencing service, please submit
the following claim information:

  * Enter the appropriate CPT code
  * Select the appropriate diagnosis for the patient
  * 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
    * Box 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: STAT3 Gene Testing

Effective for dates of service on and after June 26, 2013  
  
STAT3 gene testing may be performed during the diagnosis of Autosomal Dominant
Hyper IgE Syndrome (AD-HIES). Since management is not determined by the
presence or absence of a STAT3 mutation in patients with a probable clinical
diagnosis, Palmetto GBA has determined STAT3 analysis is a statutorily
excluded test.  
  
To receive a STAT3 analysis service denial, please submit the following claim
information:

    * CPT code 81405 - STAT3, targeted sequence analysis



    * 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



    * Select the appropriate diagnosis for the patient



  * 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
    * Box 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: _CHD7_ Gene Analysis

Effective for dates of service on and after June 26, 2013  
  
 _CHD7_ gene testing may be performed during the diagnosis of CHARGE Syndrome.
Since clinical symptoms and diagnosis usually occur prior to Medicare
eligibility and carrier testing is not a covered benefit, the MolDX team has
determined _CHD7_ gene testing is a statutorily excluded service. MolDX will
also deny tests that include one or more of _CHD7_ tests reported with CPT
code 81479 as statutorily excluded services.  
  
To receive a _CHD7_ analysis service denial, please submit the following claim
information:

  * Select appropriate CPT code
    * 81407 _CHD7_ , full gene sequencing
    * 81479 all other _CHD7_ testing
  * 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
    * Box 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: PTCH1 Gene Testing

Effective for dates of service on and after June 26, 2013  
  
PTCH1 gene testing may be performed during the diagnosis of Nevoid Basal Cell
Carcinoma Syndrome (NBCCS). Since the diagnosis of NBCCS is established using
clinical diagnostic criteria and carrier testing is not a covered benefit,
Palmetto GBA has determined PTCH1analysis is a statutorily excluded test.  
  
To receive a PTCH1 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
  * Select the appropriate diagnosis for the patient
  * 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
    * Box 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: MECP2 Genetic

Effective for dates of service on and after February 19, 2013  
  
Mutations found in methyl CpG binding protein 2(MECP2) are associated with
Rett syndrome. In classic Rett syndrome, suspected cases are identified
through specific clinical criteria in female children ages 1-5. Genetic
testing is used to confirm the clinical findings. Since 99% of classic cases
result in a single random mutation, genetic testing is not useful to screen
carriers. Therefore, the MolDX Team has determined that MECP2 genetic testing
is not a Medicare benefit and is a statutorily excluded service. In addition
to single disease testing, MolDX will also deny panels of tests that include a
MECP2 gene test as a statutorily excluded service.  
To receive a MECP2 test denial, please submit the following claim information:

    * Appropriate CPT codes:  

      * 81302- MECP2, full gene sequence
      * 81303- MECP2, known familial variant
      * 81304- MECP2, duplication/deletion variants
      * 81470 - X-linked intellectual disability genomic sequence analysis panel
      * 81471 - X-linked intellectual disability genomic sequence analysis panel duplication / deletion
      * 81479-MECP2, panel
    * 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
    * Select the appropriate diagnosis for the patient
    * 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
      * Box 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
    * Box 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: NSD1 Gene Tests

Effective for dates of service on and after June 26, 2013.  
  
NSD1 gene testing may be performed during the diagnosis of Sotos Syndrome.
Since testing is limited to reproductive risk assessment, the MolDX Team has
determined NSD1 gene testing is a statutorily excluded service. MolDX will
also deny tests that include one or more of NSD1 analysis reported with CPT
code 81479 as statutorily excluded tests.  
  
To receive a NSD1 analysis service denial, please submit the following claim
information:

  * Select appropriate CPT code according to genetic material tests 
    * Code 81405 for NSD1 duplication/deletion
    * Code 81406 for NSD1 gene sequencing
    * Code 81479 for combinations of NSD1 analysis
  * 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
    * Box 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: RPS19 Gene Tests

Effective for dates of service on and after June 25, 2013.  
  
RPS19 gene sequencing, deletion/duplication and known familial mutation
analysis may be performed during the diagnosis of Diamond-Blackfan Anemia
(DBA). Since clinical symptoms and diagnosis usually occur prior to Medicare
eligibility and carrier testing is not a covered benefit, the MolDX Team has
determined RPS19 analysis is a statutorily excluded test. MolDX will also deny
tests that include one or more of RPS19 analysis reported with CPT code 81479
as statutorily excluded services.  
  
To receive a RPS19 analysis service denial, please submit the following claim
information:

  * Select appropriate CPT code according to genetic material tested 
    * Code 81405 for gene sequencing
    * Code 81479 for combinations of RPS19 analysis
  * 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
  * Select the appropriate diagnosis for the patient
  * 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
    * Box 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: TERC Gene Tests

Effective for dates of service on and after June 25, 2013  
  
Since the associated conditions associated with telomerase RNA component
(TERC) gene testing is limited to reproductive risk assessment, the MolDX team
has determined TERC gene testing is a statutorily excluded service. MolDX will
also deny tests that include one or more of TERC analysis reported with CPT
code 81479 as a statutorily excluded service.  
  
To receive a TERC analysis service denial, please submit the following claim
information:

  * CPT 81479 - Unlisted molecular pathology procedure
    * 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 modifierAn Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.
  * Select the appropriate diagnosis for the patient
  * 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
    * Box 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: TP53 Gene Test

Effective for dates of service on and after June 24, 2013  
  
TP53 gene testing may be performed during the diagnosis of Li-Fraumeni
syndrome (LFS), a cancer predisposition syndrome associated with the
development of specific tumors. Clinical symptoms and diagnosis usually occur
prior to Medicare eligibility and carrier testing is not a covered benefit.  
  
To receive a TP53 gene sequencing service denial, please submit the following
claim information:

  * Select the appropriate CPT code
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded 
    * 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 services.
  * Select the appropriate diagnosis for the patient
  * 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
    * Box 19 for paper clai
  * 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: IKBKAP Genetic Testing

Effective for dates of service on and after February 7, 2013  
  
Mutations to the IKBKAP (inhibitor of kappa light polypeptide gene enhancer in
B-cells, kinase complex-associated proteins) are associated with familial
dysautonomia (FD), a condition that affects the development of sensory,
sympathetic, and parasympathetic neurons. Genetic testing may be performed at
birth to diagnose FD. For adults, IKBKAP genetic testing identifies parents
that may be at risk for conceiving a child with the disease. Therefore, the
MolDX Team has determined that testing for the IKBKAP is not a Medicare
benefit and is a statutorily excluded service. In addition to single disease
testing, MolDX will also deny panels of tests that include an IKBKAP gene test
as a statutorily excluded service.  
  
To receive an IKBKAP test denial, please submit the following claim
information:

  * 81260-IKBKAP, common variants
  * 81412 - Ashkenazi Jewish associated disorders
  * 81443 - Genetic testing for severe inherited condition
    * 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
    * Box 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

Effective for dates of service on and after February 7, 2013  
  
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 (HEXA) 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, MolDX 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 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
      * Box 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: BCKDHB Gene Test

Effective for dates of service on and after February 7, 2013  
  
BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) gene
testing identifies mutations in the BCKDHA, BCKDHB, DBT, and DLD genes causing
maple syrup urine disease (MSUD). Genetic testing identifies parents at risk
for conceiving a child with MSUD. Therefore, the MolDX Team has determined
that BCKDHB gene testing to identify parents at risk is not a Medicare benefit
and a statutorily excluded test. In addition to single disease testing, MolDX
will also deny panels of tests that include the BCKDHB gene as a statutorily
excluded test.  
  
To receive a BCKDHB test service denial, please submit the following claim
information:

  * CPT code 81205- BCKDHB, common variants
  * CPT code 81406- BCKDHM, full gene sequence
  * CPT code 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
    * Box 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: Aspartoacyclase 2 Deficiency(ASPA) Testing

Effective for dates of service on and after 2/7/2013  
  
Asparoacyclase 2 Deficiency (ASPA) Testing, also known as Canavan Disease, is
an autosomal recessive degenerative disorder that causes progressive nerve
damage to nerve cells in the brain. Genetic testing identifies parents that
may be at risk for conceiving a child with the disease and offspring suspected
to have or diagnosed with the disease. Therefore, the MolDX Team has
determined that testing for the ASPA is not a Medicare benefit and is a
statutorily excluded test. MolDX will also deny panels that include ASPA
testing.  
  
To receive an ASPA service denial, please submit the following claim
information:

  * Select one of the following CPT codes for the performed service:  

    * 81200 - ASPA, common variant
    * 81412 - Ashkenazi Jewish associated disorders
    * 81443 - Genetic testing for severe inherited conditions
    * 81479 - Unlisted molecular pathology procedures
  * 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
    * Box 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