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 inherited 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 
  * 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 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
    * 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: 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-common variants
  * CPT code 81406-BCKDM, 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
  * 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 each code in the stack 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: BluePrint Test

The MolDX team has completed a technical assessment on BluePrint, a molecular
subtyping assay. To date, there is insufficient evidence to support the
required clinical utility for the established Medicare benefit category.
Therefore, the BluePrint test is a statutorily excluded test.  
  
To receive a BluePrint 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
  * Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information.
  * Enter 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. (Note: Only one test/identifier per paper claim may be submitted.)
  * 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: bioTheranostics Cancer TYPE ID Update

Effective November 19, 2012, Cancer TYPE ID, an RT-PCR 92-gene assay, has been
assigned a new identifier to reflect the changes in the test. To bill for
Cancer TYPE ID services, please provide the following claim information:

  * CPT code: 81540- Oncology (tumor of unknown origin) mRNA gene expression of 92 genes
  * Enter "1" in the Days/Unit field
  * 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
    * Box 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
  * Select the appropriate ICD-10-CM code.

Note: MolDX expects this test to ONLY be ordered by the treating physician.
Billing and Coding: MolDX: BLM Gene Analysis

Effective for dates of service on and after July 30, 2014.  
  
The clinical diagnosis of Bloom (BLM syndrome, BSyn), characterized by severe
pre and postnatal growth deficiency, highly characteristic sparseness of
subcutaneous fat tissue in infants and children, is confirmed through
cytogenetic testing. Molecular genetic testing identifies BLM gene mutation
carriers at risk for conceiving offspring with the disease. Therefore, BLM
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 BLM gene as a statutorily excluded service.  
  
To receive a BLM gene test service denial, please submit the following

  * CPT code 81209 or 81443
  * 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
  * 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
    * 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
Response to Comments: Benign Skin Lesion Removal (Excludes Actinic Keratosis,
and Mohs) Noridian's Response to Provider Recommendations (for comment period
ending 04/10/2016).
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
  * 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 claim Part B  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: ENG and ACVRL1 Gene Tests

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder
with variable clinical presentation. Most common manifestations are epistaxis,
recurrent gastrointestinal bleeding, iron deficiency anemia, and mucocutaneous
telangectasias. Arteriovenous malformations (AVMs), of various organs (lung,
liver, brain) are common.  
  
The two most prevalent forms of HHT, Type 1 and Type 2, are caused by
mutations in the endoglin (ENG) or the ACVRL1 gene respectively. Although
identification of these gene mutations can confirm the diagnosis of HHT, these
tests are not necessary in many cases. HHT is generally established using well
vetted consensus criteria (most often the International Curacao Criteria
(ICC)). The ICC uses the clinical characteristics of epistaxis, cutaneous or
mucosal telangectasias, visceral AVMs, and a first-degree relative with HHT to
judge likelihood of a given patient having HHT. A "definite" diagnosis is
established when a patient has 3 or 4 of these criteria. Genetic testing for
ENG/ACVRL1 is not warranted. A patient with 0 to 1 criteria is "unlikely" to
have HHT, and similarly would not be a candidate for genetic testing. Patients
with 2 or 3 Curacao criteria are defined as "suspected" of HHT and are
candidates for ENG/ACVRL1 testing.  
  
Since screening of patients without signs or symptoms of HHT, who have a
first-degree relative with HHT, is not a Medicare benefit, the MolDX Team has
determined ENG and/or ACVRL1 genetic testing and panels of tests that include
ENG/ACVRL1 are statutorily excluded services.  
  
**EXCEPTIONS:** For patients with "suspected" HHT in which diagnosis
confirmation would demonstrate an improved outcome, approval will be made on a
case-by-case basis through the appeal process.  
  
For tests that include ENG and ACVRL1 registered and assigned a single DEX
Z-CodeTM Identifier, submit CPT code 81479.  
  
To receive an ENG and/or ACVRL1 gene test denial, please submit the following
claim information:

  * Select appropriate CPT code for test 
    * 81405-ENG, Duplication/deletion
    * 81406-ENG, full gene sequence
    * 81479-ACVRL1
    * 81479-ACVRL1 and ENG
  * 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-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: FANCC Genetic Testing

Effective for dates of service on and after February 6, 2013.  
  
FANCC gene testing is performed in association with Fanconi anemia (FA), a
condition characterized by physical abnormalities, bone marrow failure, and
increased risk of malignancy. For infants and children, FANCC genetic testing
is used to confirm the clinical findings, such as blood counts and bone marrow
biopsy, to diagnose FA. Genetic testing for adults is used to screen potential
carriers of the mutation. Therefore, the MolDX Team has determined that
testing for the FANCC 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 FANCC gene.  
  
To receive a FANCC test denial, please submit the following claim information:

  * CPT code 81242- FANCC, common variant
  * CPT code 81412 - Ashkenazi Jewish Associated Disorders
  * 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 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-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: FDA-Approved BRAF Tests

Two tests have met the FDA criteria for BRAF genetic testing:

  1. Effective 09/07/2012.  
 **cobas  4800 BRAF V600** to detect the presence of a mutation in the BRAF
gene in melanoma cells and determine if a patient is eligible for Zelboraf
TM(vemurafenib), a treatment indicated for a melanoma that cannot be surgically
excised or has spread in the body.

  2. Effective 5/29/2013.   
**ThxID TM BRAF V600/K** to detect the BRAF V600E and V600K mutations in
selecting melanoma patients whose tumors carry the BRAF V600E mutation for
treatment with dabrafenib [Tafinlar] and as an aid in selecting melanoma
patients whose tumors carry the BRAF V600E or V600K mutation for treatment
with trametinib [MekinistTM].

To report an FDA approved or laboratory developed test (LDT) BRAF V600 test
kit service, please submit the following claim information.

  * CPT code 81210
  * Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information.
  * Enter the assigned DEX Z-CodeTM Identifier in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Submit the assigned DEX Z-CodeTM Identifier on an attachment to the claim form 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
  * Select the appropriate ICD-10-CM diagnosis.

**NOTE:**   All labs that submit claims for a BRAF V600 test kit **MUST**
register the test and confirm the **UNMODIFIED** use of the kit. Tests may be
registered on the DEXTM Diagnostics Exchange <https://app.dexzcodes.com/login>

This article reflects the FDA-approved indications on article creation date.
MolDX will allow future FDA approved and amended indications for these tests.
Billing and Coding: MolDX: FDA-Approved KRAS Tests

Two tests have met the Food and Drug Administration (FDA) criteria for KRAS
genetic testing:

  1. Effective 7/6/2012  
therascreen KRAS to detect somatic mutations in the human KRAS oncogene was
developed to aid in the identification of colorectal cancer (CRC) patients for
treatment with Erbitux (cetuximab).

  2. Effective 5/7/2015  
cobas KRAS to detect mutations in codons 12 and 13 of the KRAS gene was
developed to aid in identification of CRC patients for treatment with Erbitux
(cetuximab) or Vectibix (panitumumab).

To report an FDA approved or laboratory developed test (LDT) KRAS service,
please submit the following claim information.

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS).
  * Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information.
  * Enter the assigned DEX Z-CodeTM Identifier in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Submit the assigned Z-CodeTM Identifier on an attachment to the claim form 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
  * Select the appropriate ICD-10-CM diagnosis.

**NOTE:**   All labs that submit claims for a KRAS, codon 12 and 13 test kit
**MUST** register the test and confirm the **UNMODIFIED** use of the kit.
Tests may be registered on the DEX Diagnostics Exchange TM:
<https://app.dexzcodes.com/login>  
  
This article reflects the FDA-approved indications on article creation date.
MolDX will allow future FDA approved and amended indications for these tests.
Billing and Coding: MolDX: Fragile X

Effective for dates of service on and after 01/1/2013.

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-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: GBA Genetic Testing

Effective for dates of service on and after July 30, 2013.

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
    * 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: HAX1 Gene Sequencing

Effective for dates of service on and after February 6, 2013.

HAX1 gene sequencing may be performed during the diagnosis of HAX1-related
Congenital 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 Team 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-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: HBB Gene Tests

Effective for dates of service on and after 05/03/2013.

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 familial 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
  * 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
    * 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