Mental retardation (IQ ≤75) Autism spectrum disorder Single GI tract hamartoma or ganglioneuroma Continued from above Continued Fibrocystic disease of the breast Yes 81321 Lipomas any PTEN (phosphatase and Fibromas provider, tensin homolog) gene Renal cell carcinoma except with analysis; full sequence Uterine fibroids valid TAR analysis override 81322 Yes Requires documentation on the TAR that patient is any from a family with a known PTEN mutation PTEN gene analysis; known provider, familial variant except with valid TAR override Yes Requires documentation on the TAR of a negative result in the full sequence analysis in PTEN (CPT-4 any PTEN gene analysis; code and that patient meets one or more provider, duplication/deletion variant criteria listed under code 81321 except with valid TAR override Yes 81329 A TAR for CPT code 81329 requires documentation any of the following criteria: SMN1 (survival of motor provider, neuron 1, telomeric) gene The patient has clinical signs or symptoms except with analysis; dosage/deletion suspicious for spinal muscular atrophy, and valid TAR analysis, includes SMN2 The patient requires the service as a confirmatory override (survival of motor neuron 2, test for spinal muscular atrophy centromeric) analysis, if performed
Continued from above 81321 PTEN (phosphatase and tensin homolog) gene analysis; full sequence analysis Continued Yes Mental retardation (IQ ≤75) Autism spectrum disorder Single GI tract hamartoma or ganglioneuroma Fibrocystic disease of the breast Lipomas Fibromas Renal cell carcinoma Uterine fibroids any provider, except with valid TAR override 81322 PTEN gene analysis; known familial variant Yes Requires documentation on the TAR that patient is from a family with a known PTEN mutation any provider, except with valid TAR override PTEN gene analysis; duplication/deletion variant Yes Requires documentation on the TAR of a negative result in the full sequence analysis in PTEN (CPT-4 code and that patient meets one or more criteria listed under code 81321 any provider, except with valid TAR override 81329 SMN1 (survival of motor neuron 1, telomeric) gene analysis; dosage/deletion analysis, includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed Yes A TAR for CPT code 81329 requires documentation of the following criteria: The patient has clinical signs or symptoms suspicious for spinal muscular atrophy, and The patient requires the service as a confirmatory test for spinal muscular atrophy any provider, except with valid TAR override