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8.2.13.7 Genetic Testing for Colorectal Cancer
Genetic testing for colorectal cancer may be considered for reimbursement to independent laboratories with prior authorization.
Genetic testing may be provided to clients who have a known predisposition (i.e., having a first- or second-degree relative) for colorectal cancer. Results of the testing may indicate whether the client has an increased risk of developing colorectal cancer. A first-degree relative is defined as a sibling, parent, or offspring. A second-degree relative is defined as an uncle, aunt, grandparent, nephew, niece, or half-sibling.
Genetic test results, when informative, may influence clinical management decisions. Documentation in the medical record must reflect that the client or family members have been given information on the nature, inheritance, and implications of genetic disorders to help them make informed medical and personal decisions before the genetic testing.
Genetic testing for colorectal cancer may be considered for reimbursement with the following procedure codes: S3828, S3829, S3830, S3831, S3833, and S3834.
Interpretation of gene mutation analysis results is not reimbursed separately. Interpretation is part of the physician E/M service.
Procedure codes 83891, 83898, 83904, 83894, and 83912 are denied when submitted with any of the following procedure codes on the same date of service by any provider: S3828, S3829, S3830, S3831, S3833, and S3834.
Procedure codes S3828, S3829, S3830, S3831, S3833, and S3834 are limited to once per lifetime for any procedure code by any provider. Testing is limited to once per lifetime for any procedure code by any provider, regardless of whether additional services are authorized. The documentation requirements for specific procedure codes are available in the following sections titled, "Testing for Familial Adenomatous Polyposis" and "Hereditary Non-Polyposis Colorectal Cancer (HNPCC)."
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