NCD - Pharmacogenomic Testing for Warfarin Response

Based on National Coverage Determination (NCD) 90.1 - Pharmacogenomic Testing for Warfarin Response, gene testing on CYP2C9 and/or VKORC1 will only be covered through coverage with evidence development (CED). Testing will be limited to once in a lifetime per beneficiary. Only genetic testing services for beneficiaries who meet the NCD criteria and are enrolled in a clinical trial will be reimbursed. Lab providers that perform services on eligible beneficiaries and described by Current Procedural Terminology (CPT) codes 81227 and 81355 must submit the following claim items: Healthcare Common Procedure Coding System (HCPCS) code: G9143 (warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)) ICD-10-CM code: Z00.6 (Examination of participant in clinical trial) HCPCS modifier QO (Investigational clinical service provided in a clinical research study that is in an approved clinical research study) Enter the appropriate identifier adjacent to HCPCS code G9143 in the comment/narrative field of the electronic or paper claim. Note: Report only HCPCS code G9143 and 1 unit of service. Do not report CPT codes 81227 and/or 81355 on the claim. References: Medicare National Coverage Determinations (NCD) 90.1 - Pharmacogenomic Testing for warfarin Response Medicare Claims Processing Manual (Pub 100-04), Chapter 32, Section 250 - Pharmacogenomic Testing for warfarin Response.