Question:

When analyzing multiple genes (a panel) for simultaneous reporting, should a single code be used or multiple Tiers 1 and 2 codes?

Answer:

Most payers instruct that a single genomic sequencing procedures (GSP) code should be used, rather than stacking multiple Tier 1 and/or Tier 2 codes. Payers may not cover a panel that would require stacking or multiple GSP codes. When the combination of genes analyzed does not align with the description of an existing GSP code, the laboratory should consider reporting CPT® 81479 for the unlisted procedure.


CPT® is a registered trademark of the American Medical Association.

This question was answered in the July issue of our Laboratory Compliance Manager Newsletter. For more hot topics relating to laboratory services, please view our store, or call us at 1.800.252.1578 ext. 2.

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.