Question:

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?

Answer:

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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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.