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Article ID Number: A55094 Status: A-Approved
Article Title: Billing and Coding: MolDX: ApoE Genotype
Original Article Effective Date:
10/10/2016
Revision Effective Date:
08/31/2023
Article Text:
The MolDX Team has determined Apolipoprotein (Apo) E genotype testing, developed to assess the risk of cardiovascular disease, has insufficient evidence to support the required clinical utility for the established Medicare benefit category.
As reviewed, the developers described the indication to perform an Apolipoprotein (Apo) E genotype test as a risk assessment for developing a disease or condition. Risk assessment for developing a disease or condition in the absence of signs and symptoms of an illness or injury is also not defined as a Medicare benefit. Therefore, Apolipoprotein (Apo) E genotype tests used for that purpose would continue to be statutory excluded tests.
To receive an ApoE service denial, please submit the following claim information:
- CPT® code 81401- APOE, common variant
- An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
- For a voluntary issued ABN, append with GX modifier
- To indicate a statutorily excluded service, append with a GY modifier
- Enter DEX Z-Code® identifier adjacent to the CPT® code in the comment/narrative field for the following Part B claim field/types:
- Loop 2400 or SV101-7 for the 5010A1 837P
- Item 19 for paper claim
- Enter DEX Z-Code® identifier adjacent to the CPT® code in the comment/narrative field for the following Part A claim field/types:
- Line SV202-7 for 837I electronic claim
- Block 80 for the UB04 claim form
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