84999
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- To receive a CSRA denial, the claim must include the appropriate CPT code for the specific in vitro chemosensitivity/chemoresistance assay.
- For a voluntarily issued ABN, append modifier GX to the claim.
- The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.
- Include relevant medical history in the medical record that supports the need for GlycoMark® testing.
Key Coverage Criteria
- Bill GlycoMark® testing using CPT code 84378 or, if appropriate, CPT 84999.
- Coverage and medical necessity determinations for in vitro chemosensitivity and chemoresistance assays follow the Local Coverage Determination L34554.
- No clinical coverage indications are specified in this billing/coding guidance; clinical coverage criteria for GlycoMark® testing are defined in Local Coverage Determination L36761.
- GlycoMark testing for assessment of glycemic control (use when local coverage determination authorizes GlycoMark testing).
- Measurement of salivary hormones is covered when chart documentation shows signs, symptoms, or other clinical reasons for testing for Cushing's syndrome.
- Serum thallium testing is covered for beneficiaries with documented industrial thallium exposure and unexplained ataxia.
20 Active Policies
L35074 — Heavy Metal Testing
J06
A56767 — Billing and Coding: Heavy Metal Testing
J06
A57237 — Billing and Coding: GlycoMark Testing for Glycemic Control
A56872 — Billing and Coding: GlycoMark Testing for Glycemic Control
L36846 — Measurement of Salivary Hormones
Related Codes
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