Cleveland Clinic Laboratories

2013 New Molecular CPT Codes

2013 Test Name Order Code Billing Code CPT Codes 2012 CPT Codes

ACADM PCR, Complete, Tier 2 ACADM 88175 81404 83891, 83894x10, 83898x10, 83904x20 ACTA2 Gene Sequencing ACTA2 88528 81403 83898x9, 83904x9, 83891 ADmark ApoE Genotype (Symptomatic) APOALZ 82397 81401 83892, 83894, 83898, 81401, 83891 ADmark PS-1 Analysis, Symptomatic PS1SY 83019 81405 83904x10, 83909x10, 83898x10, 83891 Alpha Globin (HBA1 and HBA2) Sequencing HBA12 88847 81257 New test in 2013 Alpha Thalassemia Gene Deletion ATHAL 84123 81257 83891, 83900, 83901x8, 83894 Alpha-1-Antitrypsin Quantitation and Phenotyping PHA1A 84187 81332 82103, 82104 Angelman UBE3A Sequencing UBE3A 88200 81331 83898x8, 83904x10, 83909x10 APO E Genotype APOEG 79374 81401 83891, 81401, 83898, 83896x2 ARX Sequence Analysis ARXSEQ 87860 81404 83890, 83898x5, 83894, 83904x6 Autoimmune Polyglandular Syndrome Evaluation AIRE 83293 81479 83909x14, 83891, 83898x14, 83904x14 Autosomal Dom Ataxia Evaluation AUTOAT 82179 81401, 83909x88, 83898x88, 83904x77, 81479x13 83891 Barth Syndrome, Carrier BARCAR 82536 81406 83891, 83898, 83904x2 Barth Syndrome, Initial Patient BARINI 82535 81406 83891, 83898, 83904x9 Bartonella PCR, Tissue TBART 87924 87471 83898x4, 83890, 83894 B-Cell Clonality Using BIOMED-2 PCR Primers BCBMD 87904 81261, 83891, 83900, 83909x5, 83898x3, 83901x2, 81264 83912, 81261, 81264 BCL 2 mbr (PCR) BCL2 81099 81401 81401, 83890, 83898, 83894, 83912 BCR/ABL Kinase Domain Mutation Analysis KINASE 84529 81403 83891, 83898, 83902, 83904x4, 83912, 81403, 83909x2 BCR/ABL Kinase Domain RT-PCR KDPCR 87994 81479 83891, 83902, 83898, 83912 BCR/ABL p190 RT-PCR, Qualitative 190BCR 87709 81207 83891, 83902, 83896x4, 83912, 83898x4, 81207 BCRABL p210 RTPCR Quantitative BCRPCR 82737 81206 81206, 83891, 83902, 83898x4, 83896x4, 83912 Beta Globin (HBB) Gene Sequencing BGHBB 88848 81401 New test in 2013 BRAF V600E Blood, Bone Marrow BRAFBM 88453 81210 81210, 83891, 83907, 83900, 83901, 83909 BRAF V600E Sequencing BRAF 87800 81210, 88381, 83894, 83904x2, 83912, 81210, 83891, 88381 83898, 83909x2 Cadasil Evaluation Complete CADASL 82122 81406 83891, 83898x23, 83904x23, 83909x23 Calpain 3 DNA Sequencing CALP3 83055 81406 83909x22, 83891x22, 83898x22, 83904x22 Canavan Disease Mutation, Fluid CANV2 83013 81200 83900, 83891, 83894, 83901, 83893x4, 83896x4 Canavan Disease Mutation, Whole Blood CANVAN 83014 81200 83896x4, 83893x4, 83894, 83900, 83901, 83891 Carnitine Palmitoyl Transferase II Deficiency CPT2 88144 81404 83891, 83898x5, 83904x3, 83894x3 CDKL5-Related Atypical Rett Syndrome CDKL5 87776 81406 83898x10, 83904x10, 83909x10 CEBPA Mutation Analysis CEBPA 87639 81403 83891, 83898x4, 83901, 83909x3, 83892x4, 83900, 83904x4 Chromosomal Microarray OS (oligo-based) CRMCMA 88500 81228, 83891, 88386x6, 88291 88291

1 2013 New Molecular CPT Codes (cont.) 2013 Test Name Order Code Billing Code CPT Codes 2012 CPT Codes

CMT Evaluation Partial CMTEVL 82114 81325 83901x42, 83898x68, 83891, 83900, 83904x68, 83909x70, 83914x46 CMT Evaluation, Complete CMTCOM 82413 81325 83898x143, 83900, 83901x42, 83909x145, 83914x46, 83904x143, 83891 CMV Genotype CMVGEN 84053 87910 83891x15, 83890, 83909x10, 83898x5, 83904x10 COL1A1/COL1A2 DNA Sequencing COLA12 84273 81408x2 83891, 83904x62, 83898x40, 83898 COL3A1 Gene Sequencing (Blood) COL3 88543 81406 83898x25, 83904x32, 83891, 81406 Complete HNPP Evaluation HNPP 82120 81324, 83891, 83904x4, 83894x4, 83901x31, 83909x5, 81325 83914x33, 83900 Connexin 26 CON26 81933 81252 83909x3, 83891, 83904x3, 83898x3 Constitutional Whole Genome SNP Microarray WGSNP 88472 81229, 88386x4, 83891, 83892x2, 83894x3 88230 Cystic Fibrosis (ACOG) Panel CFSCRN 82502 81220 83900, 83901x30, 83912, 83914x32, 81220, 83891, 83909 Cyto P450 2C19 Genotype 2C19PL 88307 81225 83891, 83900, 83901x4, 81225, 83914x18, 83912 Cyto P450 2C19 Genotype for Clopidogrel Therapy 2C19CL 88362 81225 83891, 83900, 83901, 83914x6, 83912, 81225 Cyto P450 2D6 Genotype 2D6 87628 81226 83901x2, 83900, 81226, 83891, 83914x30, 83912 Diagnostic CF Test CFDNA 80939 81220 83891, 83901x22, 83914x97, 83900 Diagnostic CFTR Intron 8 CFTR 80937 81224 83891, 83894, 83893x3, 83898, 83896x3 DM1 DNA Test DM1DNA 82403 81401 83891, 83909, 83898 DM2 DNA Test DM2DNA 82402 81479 83891, 83909, 83898 DPD 5FU GenotypR 5FU 84203 81400 83891, 83914, 83898, 83909, 83892x3 DRPLA DNA Test DRPLA 82268 81401 83890, 83898, 83909 Duchenne/Becker Muscular Dystrophy DNA Carrier Test DBMDXS 83006 81161 83900, 83901x93, 83909x2, 83914x95, 83891 (females only) Duchenne/Becker Muscular Dystrophy DNA Del Test DBMDYS 82119 81161 83901x93, 83909x2, 83914x95, 83891, 83900 (males only) Dystonia DNA Test DYSTON 83018 81400 83909, 83891, 83898 Early Onset Obesity Evaluation OBESTY 83295 81479 83909x3, 83891, 83898x3, 83904x3 EGFR Mutation Analysis EGFR 83969 81235, 83907, 83891, 83896x29, 83898x4, 83914x29, 88381 88381, 83900, 83901x23 EGFR Mutation Analysis, Cell Pellet EGFRCP 88871 81235 New test in 2013 EGFR Mutation Analysis, Tissue EGFRTI 88877 81235, New test in 2013 88381 Endocrine Hypertension (HSD11B2) Evaluation HSD1B2 83329 81479 83909, 83891, 83898x6, 83904x6 EPM1 DNA EPMDNA 82118 81401 83891, 83892, 83894, 83896, 83897 Exercise Intolerance Mutation Profile XCISE 84411 81406, 83891, 83893x2, 83894, 83892x2, 83896x2, 81404, 83898 81479 Factor V Leiden FVLEID 79827 81241 81241, 83891, 83898, 83896x2, 83903, 83912 Factor XIII V34L DNA XIIIVL 83871 81400 83890, 83898, 83896x2 FALS Disease DNA Test FALS 82343 81403 83909x5, 83891, 83898x5, 83904x5 Familial Hypocalciuric Hypercalcemia Evaluation FHHE 83294 81479 83891, 83898x11, 83904x11 Familial Mediterranean Fever, Complete FAMMED 82936 81479 83891x7, 83898x10, 83894x7, 83904x9, 83892x4 FAP Mutation Screen FAPSCR 82499 81201, 83905x4, 83914x26, 81405, 83909x31, 81405 83906x4, 83894x8, 83898x5, 83891, 83900, 83892x4, 83901x10

2 2013 New Molecular CPT Codes (cont.) 2013 Test Name Order Code Billing Code CPT Codes 2012 CPT Codes

FAP, Known Mutation FAPKNO 82498 81202 83909x2, 83891, 83894, 83898, 83892 FBN1 Gene Deletion/Duplication Analysis FBN1DD 88573 81479 83890, 83892x2, 83894, 83896x4 FBN1 Gene Sequencing Analysis FBN1 88568 81408 83890, 83898x58, 83894x58, 83904x63, 81407 Fragile X Syndrome DNA Analysis FRAGIL 82365 81243 83893, 83900, 83892x3, 83894, 83909, 83891, 83896, 83897 Friedreich’s Ataxia DNA Test FRIED 82524 81404 83891, 83894, 83898 FSHD DNA Test FSHDNA 82117 81404 83891, 83892x2, 83896, 83897, 83894, 83907 Gaucher Disease Mutation, Fluid GAUCH 83011 81251 83893x5, 83894x2, 83896x5, 83898, 83900 Gaucher Disease Mutation, Whole Blood GAUCHR 83012 81251 83893x5, 83894x2, 83896x5, 83898, 83900 GCH1 Gene Analysis GCH1 88170 81479 83891, 83898x5, 89894x2, 83904 GCK (CH) DNA Sequencing Test GCKCH 83323 81406 83891, 83904x9, 83909x9, 83898x9 GCK (NDM) DNA Sequencing Test GCKNDM 83328 81406 83909x9, 83891, 83898x9, 83904x9 Gene Analysis 21 Hydroxylase 21GENE 88173 81405 83892x2, 83894, 83900, 83901x2, 83909x16 GLA Gene Testing in Fabry Disease FABRY 82954 81405 83891, 83898x8, 83909x16 Glucose Transporter Deficiency SLC2A1 SLC2A1 88160 81479 83904x6, 83894x5, 83898x5, 83891 GLUD1 (CH) DNA Sequencing Test GLUD1 83324 81479 83898x14, 83909, 83891, 83904x14 Hemiplegic Migraine Evaluation HEMMIG 87713 81407, 83891, 83904x83, 83909x83, 83898x83 81479x2 Hereditary Pancreatitis HERPAN 82734 81401 83898x2, 83909x4, 83890, 83892x2, 83894x2 HFE (Hemochromatosis) HEMDNA 79903 81256 83891, 83896x2, 83900, 81256, 83912 HLA B5701 B5701 84337 81381 83900, 83894, 83901 HLA-A HLAA 82627 81380 83900, 83891, 83904x6 HLA-A, B & C HLABC 82817 81372 83891, 83896x90, 83900 HLA-A29 DNA Typing HLAA29 88634 81374 83891, 83896x30, 83900 HLA-B HLAB 82659 81380 83891, 83900, 83904x6 HLA-B27 PCR B27PCR 83080 81374 83891, 83898, 81374 HLA-DR HLADR 83639 81376 83898, 83891, 83896x15 Huntington Southern Blot reflex HUNTSB 84185 81479 83892, 83897, 83894, 83896, 83891 Huntington’s Disease HUNTDI 81571 81401 83891, 83909, 83898 Hypercholesterolemia (LDLR Evaluation) LDLR 83322 81401 83909, 83891, 83898x18, 83904x18 IgH and TCRB Southern Blot IMGENE 83069 81262, 83912, 83892x7, 83894x2, 83896x3, 83890 81341 IGH (SBH) IGHSB 83976 81262 83892, 83896, 81262, 83890, 83894, 83912 IgVH Mutation Analysis IGVH 88056 81263 83891, 83902, 83898x5, 83894 IgVH Mutation Analysis, Billing reflex IGVHSQ 88080 81479 83892, 83904, 83909 Immunoglobulin Heavy Chain Using Biomed-2 PCR Primers IGHPCR 87960 81261 83898x3, 83909x3, 83912, 81261, 83891 Immunoglobulin Kappa Chain using Biomed-2 PCR Primers IGKPCR 87954 81264 83891, 83900, 83909x2, 83912, 83901x4, 81264 Interleukin 28B Associated Variants, 2 SNPs IL28B 88185 81479 83891, 83900, 83896x4 IPF1 (MODY4) DNA Sequencing Test MODY4 83310 81404 83891, 83898x4, 83904x4, 83909x4 IPF1 (NDM) DNA Sequencing Test IPFNDM 83325 81404 83898x4, 83909x4, 83891, 83904x4 JAK2 Exon 12 and Non-V617F Mutation JAKNON 87775 81403 83891, 83902, 83909x2, 83898, 83904x2 JAK2 V617F Mutation Detection JAK2 83623 81270 83896x4, 81270, 83891, 83898x2, 83912 KCNJ11 (CH) DNA Sequencing Test KCNJCH 83357 81479 83898x4, 83909x4, 83891, 83904x4 KCNJ11 (NDM) DNA Sequencing Test KCNJ 83327 81479 83909x4, 83898x4, 83891, 83904x4 Kennedy’s Disease DNA Test KENEDY 82948 81401 83890, 83898, 83909

3 2013 New Molecular CPT Codes (cont.) 2013 Test Name Order Code Billing Code CPT Codes 2012 CPT Codes

KIT Asp816Val Mutation Analysis KITMST 84159 81402 83909x2, 83898x2 KIT Gene Mutation AML KITAML 84158 81404 83891, 83903x5, 83898x5, 83892x5, 83904x10 KRAS Exon 1 Sequence Analysis KRAS 83968 81275 83912, 83898, 83909x2, 81275, 83894, 83904x2, 83907 LHON mtDNA Mutation LHON 81739 81401 83891, 83898x2, 83894, 83892x2 LOH for 19q 19QPCT 83656 81401 83912, 83898x8, 83891x2, 83909x8 LOH for 1p (PCR) 1PPCRT 81883 81401 83891x2, 83901x3, 83898x2, 83909x8, 83912, 83900 Maternal Cell Contamination MATRNL 83042 81265 83901x11, 83909, 83891, 83900 Medium Chain Acyl-CoA Dehydrogenase, Tier 1, Targeted MCADD 88176 81400 83891, 83894x3, 83898x3, 83904x2 MELAS mtDNA Profile MELAS 82401 81401 83909, 83891, 83892x5, 83904, 83898x6 MEN2 and FMTC Mutation MEN2 83405 81404 83904x6, 83891x2, 83909x6, 83892x2, 83898x6 MERRF mtDNA Evaluation MERRF 82400 81401 83898x4, 83891, 83892x4, 83909x4 MFN2 DNA Sequencing Test MFN2 83400 81479 83898x15, 83891, 83904x15, 83909x15 MGMT Methylation MGMT 88780 81479 83891, 83907, 83898, 83904, 83912 Mitochondrial DNA Copy Number CNUMB 88594 81406 83896x3, 83898x15, 83891 Mitochondrial DNA Deletion Analysis DNADEL 88557 81479, 83894x2, 83892x2, 83896x2, 83897, 83891 81401 Mitochondrial DNA/nuclear DNA ratio MTRAT 88563 81479, 84311, 83896x5, 83898x2, 83891 84311 Molecular Detection of TSHR TSHR 84354 81479 83891, 83902, 83894, 83913, 83898x2, 83912 Monogenic Diabetes (MODY) Evaluation MODY 83309 81403 83900, 83898x43, 83901x42, 83904x43, 83909x44, 83914x44, 83891 MPL Mutational Analysis, Blood or Bone Marrow MPL 87657 81403 83904, 83898, 83890 MPL Mutational Analysis, extracted DNA MPLDNA 87658 81403 83898, 83890, 83904 MSI (PCR x2) MSICCT 82447 81301, 83891x2, 88381x2, 83900, 83901x12, 83909x2, 88381x2 83912 MSI (PCR x3) MS-I3 84483 81301, 83901x20, 83909x3, 83912, 83900, 83891x3, 88381 88381x3 MTHFR by PCR MTHFR 81692 81291 81291, 83891, 83896x2, 83898, 83903, 83912 Muckle-Wells Syndrome MUCKLE 82909 81479 83892x2, 83891x6, 83898x12, 83894x6, 83904x12 Multifocal Neuropathy Evaluation MULNEU 82185 81324, 83900, 83520x4, 83909, 83901x17, 83516, 83516, 83914x19, 83891 83520x4 MVK Testing in Hyper-IgD Syndrome MVK 83020 81479 83892x2, 83891x5, 83898x5, 83894x5, 83904x5 Myelin Protein Zero DNA Sequencing Test MPZERO 82186 81405 83909x6, 83904x6, 83891, 83898x6 Narcolepsy Evaluation NARCO1 82483 81383x2, 83901, 83896x35, 83898, 83900, 83891 81377 Neurofibromatosis Type 1, Comprehensive NFIB1 88611 81408, 83891x3, 83903, 83913, 83909x9, 83894x3, 88230 83896x2, 83898x16, 83900, 83902, 83904x18, 88230, 81408 Neurofibromatosis Type 2 DNA NEUFIB 82303 81405 83903x18, 83891, 83904x18, 83909x18, 83898x18 Niemann-Pick Disease Type A Mutation, Fluid NIEM2 83016 81330 83893x3, 83894, 83896x3, 83900 Niemann-Pick Disease Type A Mutation, Whole Blood NIEMAN 83015 81330 83893x3, 83894, 83896x3, 83900 Nucleophosmin Gene (NPM1 Mutation) NPM1 83919 81310 83898x2, 83909x2, 81310, 83912 Ocular Cytomegalovirus PCR VITCMV 84523 87496 83890, 83898, 83894 Ocular Herpes Simplex 1 and 2 PCR VITHSV 84525 87529 83890, 83898, 83894, 83892

4 2013 New Molecular CPT Codes (cont.) 2013 Test Name Order Code Billing Code CPT Codes 2012 CPT Codes

Ocular Toxoplasma Gondii PCR VITTXO 84524 87798 83890, 83898, 83894 Ocular Varicella Zoster Virus PCR VITVZV 84526 87798 83890, 83894, 83898 OncoChip Copy Number CNE 88012 81228 88386x6, 83891 Oncologic CytoScan HD SNP Array HDSNP 88609 81406, 83891, 83892, 83894x2, 83898, 88230, 88230, 88271x82 88271x82 OPMD DNA Test OPMD 82199 81479 83891, 83894, 83898, 83909 P53 Mutation Analysis P53MUT 88213 81405 83891, 83892x10, 83898x10, 83903x10 PAI-1 Genotype 5G/4G PAIGEN 83781 81400 83898, 83896, 83890 Pancreatitis Panel PANCPL 83724 81223, 83894x2, 83903x30, 83909x2, 83891, 81404, 83898x65, 83904x2 81479 PAX6 Gene Analysis PAX6 88489 81479, 83891x16, 83898x32, 83894x32, 83904x32, 88271x10 88386, 83892x2 PINK1 DNA Sequencing PINK1 83049 81479 83891, 83898x8, 83904x8, 83909x8 PLA 1/2 by PCR PLAPCR 81691 81400 83890, 83892, 83898, 83894, 83912, 81400 PML/RARA RTPCR APLPCR 82570 81315 83902, 83894, 81315, 83891, 83898x3, 83912 PMP22 DNA Sequencing Test PMP22 82201 81325 83891, 83898x4, 83904x4, 83909x4 PMP22 Duplication/Deletion DNA PMPDEL 82200 81324 83891, 83900, 83909, 83901x31, 83914x33 POLG1 Sequencing POLG1 83993 81406 83898x22, 83904x22, 83909x22, 83891 POLG2 Sequencing POLG2 88169 81479 83891, 83898x5, 83904x3, 83894x3 Prader-Willi/Angelman Methylation PRADER 82164 81331 83891, 83892, 83894, 83900 Prometheus Celiac Genetics CELIA 82969 81382x2 83891, 83896x100, 83901x2, 83900 Prometheus Celiac PLUS CEPLUS 84315 81382x2, 88347, 83891, 82784, 83900, 83896x100, 83520x3, 83901x2, 83520x3 88347, 82784 Prometheus Crohn’s Prognostic CROHN 88579 81401, 83520x5, 88347x2, 83907, 83896x6, 83898x3 83520x5, 88347x2 Prometheus IBD sgi Diagnostic IBDSGI 88291 81479x4, 82397x3, 83520x8, 83896x8, 83898x4, 83907, 82397x3, 86140, 88347x2 83520x8, 86140, 88347x2 PRO-PredictR TPMT PPTMPT 81267 81401 83891, 83898x3, 83896x6 Prostate Cancer Biomarker PCA3 87736 81479 83891x2, 83896x2, 83902x2, 83892x2, 83898x2, 83913x2, 83912 Prothrombin Gene Mutation PTGENE 80095 81240 83891, 83898, 83912, 83896x2, 83903, 81240 PTEN Gene Analysis PTEN 83917 81321, 83892x2, 83891x12, 83904x22, 88386, 81323 83894x11, 83898x22 Rett Syndrome RETT 81741 81302, 83898x8, 83904x6, 83914, 83909x2, 83891, 81304 83896 SCA14 DNA Test SCA14 83054 81479 83891, 83904x16, 83909x16, 83898x16 SCA17 DNA Test SCA17 82204 81479 83909, 83891, 83898 SCN1A DNA Sequencing Test SCN1A 83056 81407 83891, 83904x34, 83898x34, 83903x34 SETX DNA Sequencing SETX 83050 81479 83891, 83904x35, 83898x35, 83909x35 Short Stature Sequencing SHOX1 84048 81479 83904x2 SHOX DNA Diagnostic SHOX 84044 81479 83891, 83903x14, 83898x12, 83894 SMAD3 Gene Sequencing SMAD3 88524 81406 83898x8, 83904x8, 83891

5 2013 New Molecular CPT Codes (cont.) 2013 Test Name Order Code Billing Code CPT Codes 2012 CPT Codes

Spinal Muscular Atrophy DNA Test SMADNA 82399 81401 83891, 83909, 83901x14, 83914x16, 83900 T-Cell Clonality Using Biomed-2 PCR Primers TCBMD 87903 81342, 83891, 83900, 83909x5, 81342, 81340, 81340 83901x7, 83898, 83912 T-Cell Receptor Beta Biomed-2 PCR TCRB 87965 81340 83891, 83900, 83912, 83901x3, 83898, 83909x3, 81340 TCRB (SBH) TCRBSB 83977 81341 83890, 83894, 83912, 81341, 83892, 83896 TCR-G PCR TGAMMA 81402 81342 83900, 83901x4, 83912, 83891, 83909x2, 81342 TGFBR1 and TGFBR2 for Loeys-Dietz Syndrome TGFB 88547 81405x2 83898x16, 83904x18, 83891 Transthyretin DNA Sequencing TTRDNA 81481 81404 83898x4, 83909x8, 83890 TRAPS/Familial Hibernian Fever TRAPS 82892 81479 83891x7, 83898x10, 83894x7, 83904x9, 83892x4 Vascular Disease Panel VASDPL 88461 81405x2, 83898x65, 83904x74, 83891 81479x4 von Willebrand Exon 28 Sequence Analysis EXON28 82907 81403 83891, 83898x2, 83904x4, 83892x2, 83909x8 von Willebrand Type 2N Sequence Analysis TYPE2N 82906 81401 83891, 83892x5, 83898x5, 83904x6, 81405 Warfarin Sensitivity Genotyping WARSEN 88301 81355, 81227, 83900, 83901, 83914x6, 83912, 83891 81227 Whole Mitochondrial Genome with Haplotyping GENHAP 84502 81229 83891, 83892x20, 83898x45, 83904x45, 83894, 83903x20 X-Linked Intellectual Disability (XLID) XLID 88313 81479 83890, 83900, 83898x20, 83904x26, 83909x10, 83901x75 Y-Chromosome Microdeletion YCMICR 81417 81403 83890, 83894x2, 83900x2

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