Billing and Coding: Bladder/Urothelial Tumor Markers

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Lab:
Bladder/Urothelial Tumor Markers (L36975).

CGS Administrators, LLC will only cover bladder tumor marker fluorescence in
situ hybridization (FISH) testing services when performed using validated
assays. To date, UroVysionTM Bladder Cancer Kit is the only Federal Drug
Administration (FDA) approved assay that is designed to detect aneuploidy for
chromosomes 3, 7, 17 and loss of the 9p21 locus via FISH. The assay is
performed on urine specimens from persons with hematuria suspected of having
bladder cancer as an aid for initial diagnosis of bladder carcinoma and
subsequent monitoring for tumor recurrence in patient previously diagnosed
with bladder cancer. UroVysionTM Bladder Kit services may only be billed by a
CLIA certified lab.  
  
To bill UroVysionTM Bladder Kit services, submit the following claim
information:

  * Select CPT code 88120 or 88121 as appropriate
  * 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

Laboratories reporting only the technical component for a UroVysionTM service
should append the appropriate code 88120 or 88121 with the TC modifier.  
  
All other services that meet the code 88120 or 88121 definition performed by
any provider type MUST bill the following claim information.

  * Select CPT code 88120 or 88121 as appropriate
  * 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

To register a test for a DEX Z-CodeTM identifier, follow the registration
process outlined in the MolDX Test Registration article located on the MolDX
site. Once an identifier has been assigned, submit a Technical Assessment (TA)
request as documented on the MolDX site TA Process.  
  
 **Note:** Physicians may NOT submit claims for a code 88120 and 88121
professional component when the interpretive information is provided by a lab
technician or scientist. Per Chapter 10 in the NCCI Policy Manual for Medicare
Services, Version 16.3, the physician work component requires a physician to
read, quantitate and interpret the tissues/cells stained with the probes(s).
Physicians who knowingly report and interpretation based on the documented
results of another professional may be subject to additional corrective action
including Recovery Audit Contractor (RAC) or fraud referrals.

To report a Bladder/Urothelial Tumor Marker service, please submit the
following claim information:

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Select the appropriate ICD-10 code