Billing and Coding: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs)

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs) (L37364). This contractor will provide limited coverage for Gastrointestinal Pathogen (GIP) molecular assays identified by multiplex nucleic acid amplification tests (NAATs). In immune competent beneficiaries, coverage is limited to no more than 5 bacterial targets (when not testing for clostridium difficile). Testing for 6-11 pathogens is covered when there is a clinical concern for clostridium difficile colitis, and clostridium difficile is one of the pathogens being tested. Testing for 12 or more organisms will only be covered in critically ill or immunosuppressed patients. This contractor expects that critically ill patients will be tested and managed in the appropriate inpatient facility. As such, for critically ill patients, only Part A claims should be submitted. ICD-10-CM diagnosis codes supporting medical necessity must be submitted with each claim. Claims submitted without such evidence will be denied as not medically necessary. Any diagnosis submitted must have documentation in the patient’s record to support coverage and medical necessity. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT®/HCPCS code must describe the service performed. Billing and Coding Information: To bill for GIP molecular assays identified by multiplex NAATs, please provide the following claim information: If the panel being used does not have its own proprietary CPT® code, use CPT® code 87505, 87506 or 87507 For dates of service on or after 7/1/2019, laboratories billing for services using the BioFire® FilmArray® Gastrointestinal (GI) Panel (BioFire® Diagnostics) should report 0097U Enter 1 unit of service (UOS) Enter the appropriate CPT® code in the comment/narrative field for the following Part B claim field/types: Loop 2400 or SV101-7 for the 5010A1 837P Box 19 for paper claim Enter the appropriate CPT® code in the comment/narrative field for the following Part A claim field/types: Line SV202-7 for 837I electronic claim Block 80 for the UB04 claim form ICD-10-CM diagnosis code(s) as set forth below.