Billing and Coding: Urinary Biomarkers for Chronic Pain Management

This article provides billing and coding guidance for urinary biomarkers used in chronic pain management rather than clinical coverage criteria; refer to local coverage determination DL39616 for coverage decisions. Claims must include a valid ICD‑10‑CM diagnosis and, when applicable, the referring/ordering physician name and NPI; use CPT 0117U with 1 unit to bill the Foundational Pain Index. Non‑covered scenarios require appropriate ABN modifiers (GA, GX, GY, GZ) with associated submission rules (Part A MAC requires occurrence code 32 and ABN date), and MolDx technical assessments or DEX Z‑codes are not required for this test.

"Coverage indications are not specified in this billing/coding guidance; refer to local coverage determination DL39616 for clinical coverage criteria."

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