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81211
Quick jump to procedure code: Printer Friendly Version
81213

CPT® 81212: BRCA1, BRCA2 (BREAST CANCER 1 AND 2) (EG, HEREDITARY BREAST AND OVARIAN CANCER) GENE ANALYSIS; 185DELAG, 5385INSC, 6174DELT VARIANTS

Short Description: Brca1&2 185&5385&6174 var

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
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TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State
2016 Laboratory Fee Schedule: $176.44


2016 OPPS Status Indicator: A

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
No ICD-9 claims data for this code.

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

81212 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 81212

CCI and MUE Edits*         Hide this section.

CCI Edits for 81212
Denied Codes (1)
Effective
Modifier
Accepted (2)
81211 Brca1&2 seq & com dup/del
04/01/2013 Yes
81213 Brca1&2 uncom dup/del var
04/01/2013 Yes
81214 Brca1 full seq & com dup/del
01/01/2013 No
81215 Brca1 gene known fam variant
04/01/2013 Yes
81216 Brca2 gene full sequence
01/01/2013 No
81217 Brca2 gene known fam variant
04/01/2013 Yes
84311 Spectrophotometry
10/01/2013 Yes
87140 Culture type immunofluoresc
01/01/2015 Yes
87143 Culture typing glc/hplc
01/01/2015 Yes
87147 Culture type immunologic
01/01/2015 Yes
87149 Dna/rna direct probe
01/01/2015 Yes
87150 Dna/rna amplified probe
01/01/2015 Yes
87152 Culture type pulse field gel
01/01/2015 Yes
87153 Dna/rna sequencing
01/01/2015 Yes
87158 Culture typing added method
01/01/2015 Yes
87470 Bartonella dna dir probe
01/01/2015 Yes
87471 Bartonella dna amp probe
01/01/2015 Yes
87472 Bartonella dna quant
01/01/2015 Yes
87475 Lyme dis dna dir probe
01/01/2015 Yes
87476 Lyme dis dna amp probe
01/01/2015 Yes
87477 Lyme dis dna quant
01/01/2015 Yes
87480 Candida dna dir probe
01/01/2015 Yes
87481 Candida dna amp probe
01/01/2015 Yes
87482 Candida dna quant
01/01/2015 Yes
87485 Chylmd pneum dna dir probe
01/01/2015 Yes
87486 Chylmd pneum dna amp probe
01/01/2015 Yes
87487 Chylmd pneum dna quant
01/01/2015 Yes
87490 Chylmd trach dna dir probe
01/01/2015 Yes
87491 Chylmd trach dna amp probe
01/01/2015 Yes
87492 Chylmd trach dna quant
01/01/2015 Yes
87493 C diff amplified probe
01/01/2015 Yes
87495 Cytomeg dna dir probe
01/01/2015 Yes
87496 Cytomeg dna amp probe
01/01/2015 Yes
87497 Cytomeg dna quant
01/01/2015 Yes
87498 Enterovirus probe&revrs trns
01/01/2015 Yes
87500 Vanomycin dna amp probe
01/01/2015 Yes
87501 Influenza dna amp prob 1+
01/01/2015 Yes
87502 Influenza dna amp probe
01/01/2015 Yes
87503 Influenza dna amp prob addl
01/01/2015 Yes
87505 Nfct agent detection gi
01/01/2015 Yes
87506 Iadna-dna/rna probe tq 6-11
01/01/2015 Yes
87507 Iadna-dna/rna probe tq 12-25
01/01/2015 Yes
87510 Gardner vag dna dir probe
01/01/2015 Yes
87511 Gardner vag dna amp probe
01/01/2015 Yes
87512 Gardner vag dna quant
01/01/2015 Yes
87515 Hepatitis b dna dir probe
01/01/2015 Yes
87516 Hepatitis b dna amp probe
01/01/2015 Yes
87517 Hepatitis b dna quant
01/01/2015 Yes
87520 Hepatitis c rna dir probe
01/01/2015 Yes
87521 Hepatitis c probe&rvrs trnsc
01/01/2015 Yes
87522 Hepatitis c revrs trnscrpj
01/01/2015 Yes
87525 Hepatitis g dna dir probe
01/01/2015 Yes
87526 Hepatitis g dna amp probe
01/01/2015 Yes
87527 Hepatitis g dna quant
01/01/2015 Yes
87528 Hsv dna dir probe
01/01/2015 Yes
87529 Hsv dna amp probe
01/01/2015 Yes
87530 Hsv dna quant
01/01/2015 Yes
87531 Hhv-6 dna dir probe
01/01/2015 Yes
87532 Hhv-6 dna amp probe
01/01/2015 Yes
87533 Hhv-6 dna quant
01/01/2015 Yes
87534 Hiv-1 dna dir probe
01/01/2015 Yes
87535 Hiv-1 probe&reverse trnscrpj
01/01/2015 Yes
87536 Hiv-1 quant&revrse trnscrpj
01/01/2015 Yes
87537 Hiv-2 dna dir probe
01/01/2015 Yes
87538 Hiv-2 probe&revrse trnscripj
01/01/2015 Yes
87539 Hiv-2 quant&revrse trnscripj
01/01/2015 Yes
87540 Legion pneumo dna dir prob
01/01/2015 Yes
87541 Legion pneumo dna amp prob
01/01/2015 Yes
87542 Legion pneumo dna quant
01/01/2015 Yes
87550 Mycobacteria dna dir probe
01/01/2015 Yes
87551 Mycobacteria dna amp probe
01/01/2015 Yes
87552 Mycobacteria dna quant
01/01/2015 Yes
87555 M.tuberculo dna dir probe
01/01/2015 Yes
87556 M.tuberculo dna amp probe
01/01/2015 Yes
87557 M.tuberculo dna quant
01/01/2015 Yes
87560 M.avium-intra dna dir prob
01/01/2015 Yes
87561 M.avium-intra dna amp prob
01/01/2015 Yes
87562 M.avium-intra dna quant
01/01/2015 Yes
87580 M.pneumon dna dir probe
01/01/2015 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
87581 M.pneumon dna amp probe
01/01/2015 Yes
87582 M.pneumon dna quant
01/01/2015 Yes
87590 N.gonorrhoeae dna dir prob
01/01/2015 Yes
87591 N.gonorrhoeae dna amp prob
01/01/2015 Yes
87592 N.gonorrhoeae dna quant
01/01/2015 Yes
87623 Hpv low-risk types
01/01/2015 Yes
87624 Hpv high-risk types
01/01/2015 Yes
87625 Hpv types 16 & 18 only
01/01/2015 Yes
87631 Resp virus 3-5 targets
01/01/2015 Yes
87632 Resp virus 6-11 targets
01/01/2015 Yes
87633 Resp virus 12-25 targets
01/01/2015 Yes
87640 Staph a dna amp probe
01/01/2015 Yes
87641 Mr-staph dna amp probe
01/01/2015 Yes
87650 Strep a dna dir probe
01/01/2015 Yes
87651 Strep a dna amp probe
01/01/2015 Yes
87652 Strep a dna quant
01/01/2015 Yes
87653 Strep b dna amp probe
01/01/2015 Yes
87660 Trichomonas vagin dir probe
01/01/2015 Yes
87661 Trichomonas vaginalis amplif
01/01/2015 Yes
87797 Detect agent nos dna dir
01/01/2015 Yes
87798 Detect agent nos dna amp
01/01/2015 Yes
87799 Detect agent nos dna quant
01/01/2015 Yes
87800 Detect agnt mult dna direc
01/01/2015 Yes
87801 Detect agnt mult dna ampli
01/01/2015 Yes
88271 Cytogenetics dna probe
01/01/2013 Yes
88272 Cytogenetics 3-5
01/01/2013 Yes
88273 Cytogenetics 10-30
01/01/2013 Yes
88274 Cytogenetics 25-99
01/01/2013 Yes
88275 Cytogenetics 100-300
01/01/2013 Yes
88291 Cyto/molecular report
10/01/2013 Yes
88364 Insitu hybridization (fish)
01/01/2016 Yes
88365 Insitu hybridization (fish)
01/01/2013 Yes
88366 Insitu hybridization (fish)
01/01/2015 Yes
88367 Insitu hybridization auto
01/01/2013 Yes
88368 Insitu hybridization manual
01/01/2013 Yes
88369 M/phmtrc alysishquant/semiq
01/01/2016 Yes
88373 M/phmtrc alys ishquant/semiq
01/01/2016 Yes
88374 M/phmtrc alys ishquant/semiq
01/01/2015 Yes
88377 M/phmtrc alys ishquant/semiq
01/01/2015 Yes
G0476 Hpv combo assay ca screen
07/01/2016 Yes
81228 Cytogen micrarray copy nmbr
01/01/2014 Yes
81229 Cytogen m array copy no&snp
01/01/2014 Yes
81410 Aortic dysfunction/dilation
01/01/2016 Yes
81411 Aortic dysfunction/dilation
01/01/2016 Yes
81412 Ashkenazi jewish assoc dis
01/01/2016 Yes
81415 Exome sequence analysis
01/01/2016 Yes
81416 Exome sequence analysis
01/01/2016 Yes
81417 Exome re-evaluation
01/01/2016 Yes
81420 Fetal chrmoml aneuploidy
01/01/2016 Yes
81425 Genome sequence analysis
01/01/2016 Yes
81426 Genome sequence analysis
01/01/2016 Yes
81427 Genome re-evaluation
01/01/2016 Yes
81430 Hearing loss sequence analys
01/01/2016 Yes
81431 Hearing loss dup/del analys
01/01/2016 Yes
81432 Hrdtry brst ca-rlatd dsordrs
01/01/2016 Yes
81433 Hrdtry brst ca-rlatd dsordrs
01/01/2016 Yes
81434 Hereditary retinal disorders
01/01/2016 Yes
81435 Hereditary colon ca dsordrs
01/01/2016 Yes
81436 Hereditary colon ca dsordrs
01/01/2016 Yes
81437 Heredtry nurondcrn tum dsrdr
01/01/2016 Yes
81438 Heredtry nurondcrn tum dsrdr
01/01/2016 Yes
81440 Mitochondrial gene
01/01/2016 Yes
81442 Noonan spectrum disorders
01/01/2016 Yes
81445 Targeted genomic seq analys
01/01/2016 Yes
81450 Targeted genomic seq analys
01/01/2016 Yes
81455 Targeted genomic seq analys
01/01/2016 Yes
81460 Whole mitochondrial genome
01/01/2016 Yes
81465 Whole mitochondrial genome
01/01/2016 Yes
81470 X-linked intellectual dblt
01/01/2016 Yes
81471 X-linked intellectual dblt
01/01/2016 Yes
81493 Cor artery disease mrna
01/01/2016 Yes
81504 Oncology tissue of origin
01/01/2014 Yes
81507 Fetal aneuploidy trisom risk
01/01/2014 Yes
81519 Oncology breast mrna
07/01/2015 Yes
81525 Oncology colon mrna
01/01/2016 Yes
81528 Oncology colorectal scr
01/01/2016 Yes
81540 Oncology tum unknown origin
01/01/2016 Yes
81545 Oncology thyroid
01/01/2016 Yes
81595 Cardiology hrt trnspl mrna
01/01/2016 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 81212.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 81212


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Nature of Analyte Nature of Analyte Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   81212 Top 5 Ordering Organizations National*
MYRIAD GENETIC LABORATORIES, INC.-UT 1,520
GENEDX, INC.-MD 122
QUEST DIAGNOSTICS CLINICAL LABORATORIES INC-NY 47
UNIVERSITY OF MIAMI DERMATOLOGY & CUTANEOUS SURGERY-FL 15
YALE UNIVERSITY-CT 11

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 81212*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 2,461
Total Services Denied 2014: 725 (29.5%)
National Charges Submitted 2014: $ 1,500,694.00
National Charges Allowed 2014: $ 305,435.00
National Average (No Modifier) Fee Submitted 2014: $610.82
National Average (No Modifier) Fee Allowed 2014: $175.95


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
2,455 99.8% $609.41 719 29.3%
Pathology 3 0.1% $860.00 3 100.0%
Internal medicine 2 0.1% $860.00 2 100.0%
Obstetrics/gynecology 1 0.0% $300.00 1 100.0%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 2,454 99.7% $609.54 718 29.3%
Office 6 0.2% $766.67 6 100.0%
Nursing facility 1 0.0% $291.56 1 100.0%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 1,877 76.3% $610.82 250 13.3%
GA - Advanced Beneficiary Notice (ABN) on File 407 16.5% $575.00 402 98.8%
90 - Reference (Outside) Laboratory 98 4.0% $500.00 33 33.7%
59 - Distinct Procedural Service 39 1.6% $1220.41 35 89.7%
91 - Repeat Clinical Diagnostic Laboratory Test 36 1.5% $575.00 1 2.8%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.



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07/29/2016 08:56:42 54.196.101.145

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