Code Description CPT
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) (MatePair Targeted Rearrangements, Oncology, Mayo Clinic)
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) ( MatePair Targeted Rearrangements, Hematologic, Mayo Clinic)
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 ( JAK2 Mutation University of Iowa, Department of Pathology)
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) (new code effective 1/1/18)
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 14 genes, including ATM, BRCA1, BRCA2, BRIP1, CDH1, MLH1, MSH2, MSH6, NBN, PALB2, PTEN, RAD51C, 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
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 atleast 15 genes, including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO, RP1, RP 2, RPE65, RPGR, and USH2 A
81435 Hereditary colon cancer syndromes (eg, Lynch syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include analysis of at least 7 genes, including APC, CHEK2, MLH1, MSH2, MSH6, MUTYH, and PMS2
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
81455 Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA 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
81479 Unlisted molecular pathology procedure
Introduction
A genetic panel is a test that measures many genes at one time. Next – generation sequencing (NGS) is specific technology that conducts the test very quickly and can look at many genes at once. NGS panels are made to find changes in genes (variants ) that might show more risk to certain cancers, including inherited form s of cancer. NGS panels report a huge volume of data. However, it is not known how to use the data to make medical decisions. Often a lot of unusable data is reported. Published medical studies have not shown that using the information from NGS panels improve a person’s medical care. Genetic panels that use NGS are considered investigational and unproven. The health plan does not pay for investigational services.
Note:
The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria . The rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for providers . A provider can be a person, such as a doctor, nurse, psychologist, or dentist. A provider also can be a place where medical care is given, like a hospital, clinic, or lab. This policy informs them about when a service may be covered.
Coding
Note : CPT codes, descriptions and materials are copyrighted by the American Medical Association (AMA). HCPCS codes, descriptions and materials are copyrighted by Centers for Medicare Services (CMS).
Genetic Counseling
Experts recommend formal genetic counseling for patients who are at risk for inherited disorders and who wish to undergo genetic testing. Interpreting the results of genetic tests and understanding risk factors can be very difficult for some patients; genetic counseling helps individuals understand
the impact of genetic testing, including the possible effects the test results could have on the individual or their family members. It should be noted that genetic counseling may alter the utilization of genetic testing substantially and may reduce inappropriate testing . Further, genetic counseling should be performed by an individual with experience and expertise in genetic medicine and genetic testing methods
Commercially available cancer susceptibility gene panels can test for multiple variants associated with a specific type of cancer or can include variants associated with a wide variety of cancers. While some patients may have a personal and/or family history of cancer that suggests the cancer is syndrome -related, numerous genetic variants are associated with inherited cancer syndromes. It has been proposed that variant testing using next – generation sequencing technology to analyze multiple genes at one time (panel testing) can optimize genetic testing in these patients compared with sequencing single genes.
Genetic Testing for Cancer Susceptibility
Genetic testing for cancer susceptibility may be approached by a focused method that involves testing for well-characterized variants based on a clinical suspicion of which gene(s) may be the cause of the familial cancer. Panel testing involves testing for multiple variants in multiple genes at one time.
Several companies, including Ambry Genetics (Aliso Viejo, CA) and GeneDx (Gaithersburg, MD), offer genetic testing panels that use next-generation sequencing (NGS) methods for hereditary cancers. NGS refers to one of several methods that use massively parallel platforms to allow the sequencing of large stretches of DNA. Panel testing is potentially associated with greater efficiencies in the evaluation of genetic diseases; however, it may provide information on genetic variants of uncertain clinical significance or which would not lead to changes in patient management. Currently available panels do not include all genes associated with hereditary cancer syndromes. Also, these panels do not test for variants (ie, single-nucleotide variants [SNVs]), which may be associated with a low, but increased cancer risk.
