0080U — Analysis of galectin-3-binding protein and scavenger receptor cysteine-rich type 1 protein m130 in plasma, with clinical risk factors, to evaluate probability of lung cancer
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The document provides billing, coding, and other guidelines that complement LCD BDX-XL2 (L37031); claims should follow the LCD and any prior authorization or documentation requirements specified by that LCD.
- This article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for BDX-XL2 (HCPCS L37216); consult LCD L37216 for clinical coverage criteria.
- Bill proteomics tests with an appropriate CPT code from the Multianalyte CPT code set, the NOC code 81599, or an applicable PLA code.
- Report 1 unit of service (UOS) for the proteomics CPT code on the claim.
Key Coverage Criteria
- A test is considered a proteomics test if it is a multianalyte assay that includes proteins as the major or essential analytes.
- A test is considered proteomics if it measures the interactions between analytes, including proteins.
- A test is considered proteomics if it requires informatics (e.g., nomograms, rubrics, or algorithms) to produce a result.
- A test is considered proteomics if the assay demonstrates clinical validity as a function of the interactions among the analytes measured.
- Test is a multianalyte assay that includes proteins as the major or essential analytes.
- Test measures the interactions between analytes, including protein–protein or protein–other-analyte interactions.
20 Active Policies
L36807 — MolDX: Molecular Diagnostic Tests (MDT)
J05
L37216 — BDX-XL2
J05
A57558 — Billing and Coding: BDX-XL2
J05
A59649 — Billing and Coding: MolDX: Proteomics Testing
J05
A59636 — Billing and Coding: MolDX: Proteomics Testing
Related Codes
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