Update to TAR Requirements for Molecular Pathology CPT-4 Codes

Effective for dates of service on or after June 1, 2016, CPT code 81161 (DMD [dystrophin] deletion analysis, and duplication analysis, if performed) is a Medi-Cal benefit. Code 81161 is limited to once-in-a-lifetime frequency for any provider and it must be billed with ICD-10-CM diagnosis code G71.0 (muscular dystrophy). Also effective for dates of service on or after June 1, 2016, DMD (dystrophin), full gene sequence is added for CPT code 81408 (molecular pathology procedure, Level 9). Effective for dates of service on or after July 1, 2016, several new ICD-10-CM diagnosis codes are available for use on claims for Lynch syndrome genetic testing.