MyPRSô Testing (Part A and B)

Contracted carrier and intermediary. Arkansas, Louisiana and Mississippi
Applicable States: [Arkansas-Part A and Part B] MyPRS is a test for Multiple Myeloma Gene Expression Profile. This test is used only after an initial diagnosis of multiple myeloma has been made and will be used in stratification of therapeutic interventions. Should these criteria not be met, denial will occur. The coverage is set to include only two clinical settings: 1.) once after initial diagnosis is made, and 2.) if relapse has occurred. It is expected this test will be needed no more than three times during the clinical history of a myeloma patient and not to exceed twice in one year. Edits to limit the use have been made, and denials after exceeding the limits will be reviewed in the appeals process for potential coverage. Presently the CPT code to be used for the test is CPT 88399. ëMyPRS’ should be entered in box 19, or electronic equivalent, on the claim with a diagnosis of 203.00 for initial testing after diagnosis, and 203.02 for those beneficiaries in relapse.