Coding Information

Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. CPT/HCPCS Codes: Group 1 Paragraph: N/A Group 1 CPT Codes: 81210 BRAF (B-RAF PROTO-ONCOGENE, SERINE/THREONINE KINASE) (EG, COLON CANCER, MELANOMA), GENE ANALYSIS, V600 VARIANT(S) ICD-10 Codes That Are Covered N/A C18.0 Malignant neoplasm of cecum C18.1 Malignant neoplasm of appendix C18.2 Malignant neoplasm of ascending colon C18.3 Malignant neoplasm of hepatic flexure C18.4 Malignant neoplasm of transverse colon C18.5 Malignant neoplasm of splenic flexure C18.6 Malignant neoplasm of descending colon C18.7 Malignant neoplasm of sigmoid colon C18.8 Malignant neoplasm of overlapping sites of colon C18.9 Malignant neoplasm of colon, unspecified C19 Malignant neoplasm of rectosigmoid junction C20 Malignant neoplasm of rectum C21.0 Malignant neoplasm of anus, unspecified C21.1 Malignant neoplasm of anal canal C21.2 Malignant neoplasm of cloacogenic zone C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal C43.0 Malignant melanoma of lip C43.111 Malignant melanoma of right upper eyelid, including canthus C43.112 Malignant melanoma of right lower eyelid, including canthus C43.121 Malignant melanoma of left upper eyelid, including canthus C43.122 Malignant melanoma of left lower eyelid, including canthus C43.21 Malignant melanoma of right ear and external auricular canal C43.22 Malignant melanoma of left ear and external auricular canal C43.31 Malignant melanoma of nose C43.39 Malignant melanoma of other parts of face C43.4 Malignant melanoma of scalp and neck C43.51 Malignant melanoma of anal skin C43.52 Malignant melanoma of skin of breast C43.59 Malignant melanoma of other part of trunk C43.61 Malignant melanoma of right upper limb, including shoulder C43.62 Malignant melanoma of left upper limb, including shoulder C43.71 Malignant melanoma of right lower limb, including hip C43.72 Malignant melanoma of left lower limb, including hip C43.8 Malignant melanoma of overlapping sites of skin C43.9 Malignant melanoma of skin, unspecified C79.2 Secondary malignant neoplasm of skin C91.40 Hairy cell leukemia not having achieved remission C91.42 Hairy cell leukemia, in relapse D03.0 Melanoma in situ of lip D03.111 Melanoma in situ of right upper eyelid, including canthus D03.112 Melanoma in situ of right lower eyelid, including canthus D03.121 Melanoma in situ of left upper eyelid, including canthus D03.122 Melanoma in situ of left lower eyelid, including canthus D03.21 Melanoma in situ of right ear and external auricular canal D03.22 Melanoma in situ of left ear and external auricular canal D03.39 Melanoma in situ of other parts of face D03.4 Melanoma in situ of scalp and neck D03.51 Melanoma in situ of anal skin D03.52 Melanoma in situ of breast (skin) (soft tissue) D03.59 Melanoma in situ of other part of trunk D03.61 Melanoma in situ of right upper limb, including shoulder D03.62 Melanoma in situ of left upper limb, including shoulder D03.71 Melanoma in situ of right lower limb, including hip D03.72 Melanoma in situ of left lower limb, including hip D03.8 Melanoma in situ of other sites D03.9 Melanoma in situ, unspecified ICD-10 Codes That Are Not Covered N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation 07/27/2023 R8 Updated to indicate this article is an LCD Reference Article. 07/27/2023 R7 Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added C91.40 and C91.42.  Under CMS National Coverage Policy re-added Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim effective on 03/03/2022   10/13/2022 R6 Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added C18.0, C18.1,C18.2, C18.3, C18.4, C18.5, C18.6, C18.7, C18.8, C18.9, C19, C20, C21.0, C21.1, C21.2, C21.8 03/03/2022 R5 Under CMS National Coverage Policy added regulation, Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Under Article Text, revised sentence to read, “To report an FDA approved or laboratory developed test (LDT) BRAF V600 test kit service, please submit the following claim information. “ This revision is effective on 03/03/2022.  11/01/2019 R4 11/01/2019: This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Under CPT/HCPCS Codes Group 1: Codes added CPT® code 81210. CPT® was inserted throughout the article where applicable 11/01/2019 R3 As required by CR 10901 article is converted to a formal billing and coding type article. There is no change in coverage. 10/01/2018 R2 Article is revised to add the following ICD-10 codes per the 2019 Annual Update: C43.111, C43.112, C43.121, C43.122, D03.111, D03.112, D03.121, D03.122.  The following codes are deleted:C43.11, C43.12, D03.11, D03.12. 12/14/2017 R1 Article is updated for consistency with the MolDX Contractor: to remove modifier 22 instructions; added Part A claim filing instructions and correct reference to and website address for DEX™ Diagnostics Exchange. Article number A54417 for Jurisdiction E Part A (JEA) was retired on January 29, 2018, and combined into Jurisdiction E Part B (JEB) article number A54418.  JEA and JEB contract numbers will have the same final MCD article number.