81235 No One of the following ICD-10-CM codes is required on the claim: EGFR (epidermal growth any factor receptor) gene C33, C34.00 C34.92 – provider, analysis, common variants except with valid TAR override No Not more One of the following ICD-10-CM codes is required 81236 than once on the claim (except with valid TAR): EZH2 (enhancer of zeste 2 per month polycomb repressive D47.1, D47.3, C83.30 C83.39 – complex 2 subunit) gene analysis, full gene sequence No Not more 81237 One of the following ICD-10-CM codes is required than once on the claim (except with valid TAR): EZH2 (enhancer of zeste 2 per month polycomb repressive D47.1, D47.3, C83.30 C83.39 – complex 2 subunit) gene analysis, common variant(s) No ICD-10-CM code D67 is required on the claim 81238 (except with valid TAR) F9 (coagulation factor IX) any full gene analysis sequence provider, except with TAR override Yes 81239 A TAR for CPT code requires documentation of the following criteria: DMPK (DM1 protein kinase) any gene analysis; The patient has clinical signs or symptoms provider, characterization of alleles suspicious for myotonic dystrophy type 1 except with (MD1), and valid TAR The patient requires the service as a diagnostic test override for MD1.
81235 EGFR (epidermal growth factor receptor) gene analysis, common variants No One of the following ICD-10-CM codes is required on the claim: C33, C34.00 – C34.92 any provider, except with valid TAR override 81236 EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) gene analysis, full gene sequence No One of the following ICD-10-CM codes is required on the claim (except with valid TAR): D47.1, D47.3, C83.30 – C83.39 Not more than once per month 81237 EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) gene analysis, common variant(s) No One of the following ICD-10-CM codes is required on the claim (except with valid TAR): D47.1, D47.3, C83.30 – C83.39 Not more than once per month 81238 F9 (coagulation factor IX) full gene analysis sequence No ICD-10-CM code D67 is required on the claim (except with valid TAR) any provider, except with TAR override 81239 DMPK (DM1 protein kinase) gene analysis; characterization of alleles Yes A TAR for CPT code requires documentation of the following criteria: The patient has clinical signs or symptoms suspicious for myotonic dystrophy type 1 (MD1), and The patient requires the service as a diagnostic test for MD1. any provider, except with valid TAR override