81266
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Submit the appropriate CPT code and enter 1 unit of service (UOS) adjacent to the 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 electronic claims (Loop 2400 or SV101-7 for 5010A1 837P) and for Part B paper claims (Box 19).
- 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 837I electronic claims and Block 80 for the UB04 claim form.
- When entering the DEX Z-Code on the SV101-7 documentation field for Part B claims, do not add additional characters or information on the line.
Key Coverage Criteria
- Chimerism analysis to identify appropriate donors and to monitor engraftment success or disease recurrence is a covered Medicare service.
- CPT 81265 is covered for recipient/donor testing performed to identify donors prior to transplantation.
- CPT 81266 is covered when used in bone marrow transplants to report an additional double-cord blood sample.
- CPT 81267 is covered post-transplant to confirm successful engraftment or detect disease recurrence and to report findings of pre- and post-transplant comparisons.
- CPT 81268 is covered to report chimerism using a buccal or other germline tissue specimen from the recipient post-transplantation.
- Chimerism analysis to identify appropriate donors and to monitor engraftment success or disease recurrence is a covered Medicare service.
20 Active Policies
A57772 — Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)
J05
L36807 — MolDX: Molecular Diagnostic Tests (MDT)
J05
A55621 — Billing and Coding: MolDX: Short Tandem Repeat (STR) Markers and Chimerism (CPT codes 81265-81268)
J05
A59926 — Billing and Coding: Molecular Pathology Procedures
J06
Related Codes
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