Addition of Tier 2, Molecular Pathology Procedure, Level 1 Service: IL28B

Effective for dates of service on or after October 1, 2014, IL28B service is added under CPT code 81400 (molecular pathology procedure, Level 1). Providers are required to document “IL28B” on the claim form or on an attachment. Reimbursement is based upon the following conditions:

• The patient has genotype 1 hepatitis C virus infection, and,
• Treatment will be contingent on the test results.

Submission for IL28B service requires manual review. Claims without documentation showing the preceding criteria have been met will be denied.

Source: General Medicine | September 2014 | Bulletin 483