Billing and Coding: Genetic Testing for Cardiovascular Disease

This billing and coding guidance for LCD L39082 states that currently no genes meet the ClinGen-based criteria for Medicare coverage of cardiovascular genetic testing, and CPT 81406 is not appropriate for cardiovascular genetic tests. Providers must not bill non-covered genetic tests as covered (use appropriate modifiers), and extensive medical record documentation (legibility, patient ID, clinician signature, ICD-10/CPT support, ordering clinician identity, counseling, phenotyping, and documented clinical actionability) is required for any claims or contractor review.

"Tier 2 CPT code 81406 is not appropriate to report for cardiovascular genetic testing because no genes associated with CPT 81406 meet the ClinGen evidence standards."

Sign up to see full coverage criteria, indications, and limitations.