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CPT Codes for Molecular Pathology

New American Medical Association Molecular CPT Codes

Effective January 1, 2013

The American Medical Association’s (AMA) new molecular CPT codes took effect on January 1, 2013 for purposes of Medicare reimbursement claims. Based on the new codes, the Mayo Medical Laboratories (MML) test catalog has been updated to reflect the coding suggestions for the impacted molecular tests.

All coding and billing changes associated with the new codes are reflected in the Client Price Portal.

The new codes impact MML clients in two ways:

  • CPT Coding Updates: Slightly more than 200 MML tests were impacted by the code updates. All MML tests and orderable codes impacted by the change are listed in the 2013 Molecular Pathology CPT Code spreadsheet.

  • Billing Updates: With the elimination of code stacking, MML must now bill for all elements of a test’s performance under a single CPT code. Because of this change, certain components of test performance that were previously billed separately are now included in the test billing.

Tier 2 Molecular Pathology CPT Codes

Effective July 1, 2013

The new AMA set of Tier 2 Molecular Pathology CPT codes take effect on July 1, 2013. These CPT codes are gene-specific and provide updates to testing previously coded with the unlisted CPT, 81479.

Palmetto Test Indicators for Molecular Pathology Tests

Palmetto GBA, a third-party administrator of Medicare that processes all claims for California, Nevada, and Hawaii, a McKesson Z-Code or a Palmetto Test Indicator (PTI) code to identify molecular diagnostic tests and to determine coverage and reimbursement. MML has applied for and been granted by Palmetto the attached list of PTI codes for use on our molecular diagnostic tests.