81210 No One of the following ICD-10-CM codes is required BRAF (B-Raf on the claim: C18.0 C18.9, C19, C20, C43.0 C43.9, C79.2 or any – – serine/threonine kinase), D03.0 D03.9 provider, – gene analysis, V600 except with valid TAR variant(s) override 81212 Yes Requires documentation on the TAR of the See Attachment B - Family History Screening Tool following: which is suggested for use prior to ordering BRCA BRCA1, BRCA2 gene any testing analysis; variants An individual is of an ethnicity associated with provider, the Ashkenazi Jewish population except with No additional family history may be required valid TAR override 81215 Yes See CPT code for TAR criteria and billing See CPT requirements. code 81162 BRCA1 (breast cancer 1) gene analysis; known familial variant Yes See CPT code 81162 for TAR criteria and billing See CPT 81216 requirements. code 81162 BRCA2 (breast cancer 2) gene analysis; full sequence analysis 81217 Yes See CPT code 81162 for TAR criteria and billing See CPT requirements. code BRCA2 (breast cancer 2) gene analysis; known familial variant 81218 No One of the following ICD-10-CM codes is required on the claim: (CCAAT/enhancer any binding protein [C/EBP], C92.00 C92.02, C92.40 C92.42 or – – provider, alpha) gene analysis, full C92.50 C92.52 – except with gene sequence valid TAR override
81210 BRAF (B-Raf serine/threonine kinase), gene analysis, V600 variant(s) No One of the following ICD-10-CM codes is required on the claim: C18.0 – C18.9, C19, C20, C43.0 – C43.9, C79.2 or D03.0 – D03.9 any provider, except with valid TAR override 81212 BRCA1, BRCA2 gene analysis; variants Yes Requires documentation on the TAR of the following: An individual is of an ethnicity associated with the Ashkenazi Jewish population No additional family history may be required any provider, except with valid TAR override See Attachment B - Family History Screening Tool which is suggested for use prior to ordering BRCA testing 81215 BRCA1 (breast cancer 1) gene analysis; known familial variant Yes See CPT code for TAR criteria and billing requirements. See CPT code 81162 81216 BRCA2 (breast cancer 2) gene analysis; full sequence analysis Yes See CPT code 81162 for TAR criteria and billing requirements. See CPT code 81162 81217 BRCA2 (breast cancer 2) gene analysis; known familial variant Yes See CPT code 81162 for TAR criteria and billing requirements. See CPT code 81218 (CCAAT/enhancer binding protein [C/EBP], alpha) gene analysis, full gene sequence No One of the following ICD-10-CM codes is required on the claim: C92.00 – C92.02, C92.40 – C92.42 or C92.50 – C92.52 any provider, except with valid TAR override