The MolDX team has determined that a Septin 9 methylation analysis test for colorectal cancer detection is not a Medicare covered service. Screening in the absence of signs and symptoms of an illness or injury is not defined as a Medicare benefit. Therefore, MolDX will deny Septin 9 methylation analysis tests as a statutorily excluded service.
To receive a SEPT9 service denial, please submit the following claim information:
CPT code 81327- SEPT9 (Septin9) (e.g. colorectal cancer) methylation analysis
An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services
For a voluntary issued ABN, append with GX modifier
To indicate a statutorily excluded service, append with a GY modifier
Select the appropriate diagnosis for the patient
Enter DEX Z-Code™ identifier adjacent to the 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 DEX Z-Code™ identifier adjacent in the comment/narrative field for the following Part A claim field/types:
Loop SV202-7 for the 837I electronic claim
Block 80 for the UB04 claim form
Reference: Sec. 1862 (1)(A) Statutory Exclusion covers diagnostic testing “except for items and services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member,…”
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