81202 Yes Requires documentation on the Treatment Authorization Request (TAR) of a family history of APC familial adenomatous polyposis that includes a any gene analysis; known relative with a known deleterious APC mutation provider, familial variants except with TAR override 81203 No One of the following ICD-10-CM codes is required on the claim: APC any C18.0 C18.9, D12.0 D12.9, K63.5, Z86.010 gene analysis; – – provider, duplication/deletion except with variants valid TAR override Yes 81204 A TAR for CPT code requires documentation of the following criteria: AR (androgen receptor) any gene analysis; The patient has clinical or symptoms provider, characterization of alleles suspicious for bulbar muscular atrophy, and except with The patient requires the service as a confirmatory valid TAR test for spinal and bulbar muscular atrophy override 81206 No One of the following ICD-10-CM codes is required 1 per on the claim: month BCR/ABL1 translocation analysis; major breakpoint C91.00 C91.02 or C92.10 C92.12 – – No One of the following ICD-10-CM codes is required 1 per on the claim: BCR/ABL1 translocation C91.00 C91.02 or C92.10 C92.12 analysis; minor breakpoint – – 81208 No One of the following ICD-10-CM is required on 1 per the claim: BCR/ABL1 translocation analysis; other breakpoint C91.00 C91.02 or C92.10 C92.12 – –
81202 APC gene analysis; known familial variants Yes Requires documentation on the Treatment Authorization Request (TAR) of a family history of familial adenomatous polyposis that includes a relative with a known deleterious APC mutation any provider, except with TAR override 81203 APC gene analysis; duplication/deletion variants No One of the following ICD-10-CM codes is required on the claim: C18.0 – C18.9, D12.0 – D12.9, K63.5, Z86.010 any provider, except with valid TAR override 81204 AR (androgen receptor) gene analysis; characterization of alleles Yes A TAR for CPT code requires documentation of the following criteria: The patient has clinical or symptoms suspicious for bulbar muscular atrophy, and The patient requires the service as a confirmatory test for spinal and bulbar muscular atrophy any provider, except with valid TAR override 81206 BCR/ABL1 translocation analysis; major breakpoint No One of the following ICD-10-CM codes is required on the claim: C91.00 – C91.02 or C92.10 – C92.12 1 per month BCR/ABL1 translocation analysis; minor breakpoint No One of the following ICD-10-CM codes is required on the claim: C91.00 – C91.02 or C92.10 – C92.12 1 per 81208 BCR/ABL1 translocation analysis; other breakpoint No One of the following ICD-10-CM is required on the claim: C91.00 – C91.02 or C92.10 – C92.12 1 per