81420 and 81507 No Diagnosis required for payment: Payable no more than Z33.x, Z34.x, Z3A.xx, O09.x, O2x.x Testing for Fetal once every 9 Aneuploidy - Cell Free months (once Fetal DNA Testing per pregnancy) 81435, 81436 No TAR Reimbursement for CPT-4 codes 81435 (hereditary While DHCS requires a TAR for this test, PHC has required colon cancer disorders; genomic sequence analysis any chosen to have no TAR requirement. Genomic Sequencing when CPT panel, must include analysis of at least 10 genes, provider, Procedures: Hereditary codes including APC, BMPR1A, CDH1, MLH1, MSH2, except with Colon Cancer Disorders listed are MSH6, MUTYH, PTEN, SMAD4 and STK11) and valid TAR billed 81436 (…duplication/deletion analysis panel, must override include analysis of at least 5 genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11) is limited to once-in-a-lifetime. 81435 and 81436 are reimbursable only when billed in conjunction with one of the following diagnosis codes: C17.0 C20, C24.0 C25.9, C54.0 C54.9, C65.1 – – – – C66.9, C71.0 C71.9, D23.0 D23.9, Z80.0, Z80.49, – – Z85.030 - Z85.038, Z85.040 - Z85.048, Z85.42, Z86.010
81420 and 81507 Testing for Fetal Aneuploidy - Cell Free Fetal DNA Testing No Diagnosis required for payment: Z33.x, Z34.x, Z3A.xx, O09.x, O2x.x Payable no more than once every 9 months (once per pregnancy) 81435, 81436 Genomic Sequencing Procedures: Hereditary Colon Cancer Disorders No TAR required when CPT codes listed are billed Reimbursement for CPT-4 codes 81435 (hereditary colon cancer disorders; genomic sequence analysis panel, must include analysis of at least 10 genes, including APC, BMPR1A, CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4 and STK11) and 81436 (…duplication/deletion analysis panel, must include analysis of at least 5 genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11) is limited to once-in-a-lifetime. 81435 and 81436 are reimbursable only when billed in conjunction with one of the following diagnosis codes: C17.0 – C20, C24.0 – C25.9, C54.0 – C54.9, C65.1 – C66.9, C71.0 – C71.9, D23.0 – D23.9, Z80.0, Z80.49, Z85.030 - Z85.038, Z85.040 - Z85.048, Z85.42, Z86.010 any provider, except with valid TAR override While DHCS requires a TAR for this test, PHC has chosen to have no TAR requirement.