0228U
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- Enter the appropriate DEX Z‑Code identifier adjacent to the CPT code in the comment/narrative field for Part B claims: Loop 2400 or SV101‑7 for the 837P electronic claim and Box 19 for paper claims.
- Enter the appropriate DEX Z‑Code identifier adjacent to the CPT code in the comment/narrative field for Part A claims: Line SV202‑7 for the 837I electronic claim and Block 80 for the UB‑04 form.
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.
11 Active Policies
L36807 — MolDX: Molecular Diagnostic Tests (MDT)
J05
A59649 — Billing and Coding: MolDX: Proteomics Testing
J05
A59641 — Billing and Coding: MolDX: Proteomics Testing
A59642 — Billing and Coding: MolDX: Proteomics Testing
A59646 — Billing and Coding: MolDX: Proteomics Testing
Related Codes
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