83080
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- For GM2 gangliosidoses (beta‑hexosaminidase testing): documentation of pre‑ and post‑test genetic counseling (see Appendix A for acceptable providers and credentials).
- Documentation that the testing is being done as carrier screening for couples (or individuals) who are suspected carriers and are planning pregnancy or seeking prenatal care and that no prior genetic testing results are available for interpretation, OR documentation of the individual's clinical characteristics consistent with Tay‑Sachs, Sandhoff, or A/B variant (see clinical signs listed in policy), OR documentation that testing is for preimplantation or prenatal diagnosis in a family with an identified GM2 gangliosidosis.
- For Alzheimer disease CSF Aβ and Tau testing: documentation that the individual has a diagnosis of Alzheimer disease and is being considered for treatment with an FDA‑approved Aβ monoclonal antibody (eg, lecanemab [Leqembi], donanemab [Kisunla]).
Key Coverage Criteria
- Cerebrospinal fluid (CSF) testing for Aβ (eg, Lumipulse G [0358U]) and Tau proteins when the individual is diagnosed with Alzheimer disease (AD) and is being considered for an FDA‑approved Aβ monoclonal antibody drug (eg, lecanemab-irmb [Leqembi], donanemab-azbt [Kisunla]).
- Beta‑hexosaminidase enzyme testing for GM2 gangliosidoses (CPT 83080) when all applicable criteria are met:
- - Pre‑ and post‑test genetic counseling; AND
- - Carrier screening for couples (or individuals) who are suspected carriers and are planning pregnancy or seeking prenatal care and no prior genetic testing results are available for interpretation; OR
- - Individual to be tested has clinical characteristics consistent with one of the following:
- - Tay‑Sachs disease (eg, infantile acute onset of axial hypotonia, cherry‑red spot, exaggerated startle response, regression in developmental milestones, seizures); OR
3 Active Policies
HUMANA-MOLECULAR-BIOMARKER-TESTING-FOR-NONCANCER-INDICATIONS-FL-MEDICAID — Molecular Biomarker Testing for Noncancer Indications - MEDICAID - FLORIDA
HUMANA-MOLECULAR-BIOMARKER-TESTING-FOR-NONCANCER-INDICATIONS-SC-MEDICAID — Molecular Biomarker Testing for Noncancer Indications - MEDICAID - SOUTH CAROLINA
HUMANA-MOLECULAR-BIOMARKER-TESTING-FOR-NONCANCER-INDICATIONS-KY-MEDICAID — Molecular Biomarker Testing for Noncancer Indications - MEDICAID - KENTUCKY
Related Codes
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