BRCA Testing

The following Texas Medicaid benefit changes have been made to support the 2012 HCPCS and CPT updates and are effective for dates of service on or after January 1, 2012.
Added

Limitations for added procedure codes: The total laboratory component may be reimbursed to physician providers for services rendered in the office setting; to hospital providers for services rendered in the outpatient hospital setting, and to independent laboratory providers for services rendered in the independent laboratory setting.
One service per lifetime may be reimbursed with prior authorization.

Genetic Testing for Colorectal Cancer

Added

Limitations for added procedure codes: The laboratory procedure codes above may be reimbursed to indepen¨dent laboratory providers for services rendered in the independent laboratory setting. Prior authorization is required.
Procedure codes 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81317, 81318, and 81319 are limited to once per lifetime. Additional services will not be authorized.

Genetic Testing ñ Other

Added
81200
Limitations for added procedure codes: Procedure codes 82100 and S3851 will be denied if they are billed by the same provider with the same date of service.

Laboratory Services: New Molecular Pathology Procedures Tier1/Tier2 codes for 2012

Added Procedure Codes

Limitations for added procedure codes: The following procedure codes may be reimbursed once per lifetime:

The following procedure codes may be reimbursed three per lifetime: