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CYP2C19 Gene Analysis Is a Medi-Cal Benefit and Updated Billing Requirements for SMN1 Gene Analysis
February 10, 2020CYP2C19 Gene Analysis Is a Medi-Cal Benefit:
Effective for dates of service on or after February 1, 2020, CPT code 81225 (CYP2C19 [cytochrome P450, family 2, subfamily C, polypeptide 19], gene analysis, common variants) is a Medi-Cal benefit. The frequency limit is once in a lifetime and one of the following ICD-10-CM diagnosis codes is required for reimbursement: I21.01 – I24.9. A Treatment Authorization Request (TAR) may override the frequency limit and ICD-10-CM diagnosis code requirement.
This information is reflected in the following provider manual(s):
| Provider Manual(s) | Page(s) Updated |
| Chronic Dialysis Clinics Vision Care | medi non cpt (1) |
| Clinics and Hospitals General Medicine Obstetrics | medi non cpt (1); path molec (14); tar and non cd8 (2) |
| Impatient Services | tar and non cd8 (2) |
Updated Billing Requirements for SMN1 Gene Analysis:
Effective for dates of service on or after December 1, 2019, ICD-10-CM diagnosis codes Z34.00 – Z34.03, Z34.80 – Z34.83 and Z34.90 – Z34.93 have been added to the billing requirements for CPT code 81329 (SMN1 [survival of motor neuron 1, telomeric] gene analysis; dosage/deletion analysis, includes SMN2 [survival of motor neuron 2, centromeric] analysis, if performed).
This information is reflected in the following provider manual(s):
| Provider Manual(s) | Page(s) Updated |
|
Clinics and Hospitals General Medicine Obstetrics |
path molec (30) |