As I understand the Medicare rules, physician interpretation of a molecular pathology procedure (e.g., CPT® codes 81161–81408) may be reported with HCPCS code G0452 (molecular pathology procedure; physician interpretation and report) as long as certain criteria are met. What are those criteria?


According to the Centers for Medicare & Medicaid Services (CMS) in section L of chapter 10 of the 2018 National Correct Coding Initiative Manual for Medicare Services, G0452 may be reported if the following circumstances exist.

  • The attending physician requests the interpretation.
  • The interpretation results in a written narrative report.
  • The interpretation requires the exercise of medical judgment (i.e., a nonphysician laboratory specialist did not provide the information).

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CPT is a registered trademark of the American Medical Association.