About this policy
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE). Coding Information: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported. Specific Coding Information ( Highly Multiplexed GPPs- Group 2 CPT Codes) Must be billed in POS 20, 21, 22, 23, or 81 (Urgent Care, Inpatient Hospital, Outpatient Hospital (observation), or Emergency Room), or in POS 81 (Independent Laboratory) in the case of a pre-transplant evaluation for an immune-compromised beneficiary. Outside of one of these POS, the test must be ordered by a clinician specialist in one of the following: Infectious Diseases (44), Gastroenterology (10), Oncology (83,90,91), or Transplant who is diagnosing and treating the beneficiary.* The specialist communication must be documented in the medical record. *An exception may be made in geographic locations where neither specialist can be reasonably reached by the beneficiary and the ordering provider is located closer to the beneficiary’s place of residence than the nearest infectious disease specialist. We would generally expect that beneficiaries for whom the test is ordered under this exception to be living in rural locations, islands, or some other location where access to care is limited. Documentation Requirements: The patient's medical record must contain documentation that fully supports the medical necessity for services included within the attached LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 87505 | HCPCS | Covered |
| 87506 | HCPCS | Covered |
| 87507 | HCPCS | Covered |
| A00.0 | ICD10CM | Covered |
| A00.1 | ICD10CM | Covered |
| A00.9 | ICD10CM | Covered |
| A01.00 | ICD10CM | Covered |
| A01.1 | ICD10CM | Covered |
| A01.2 | ICD10CM | Covered |
| A01.3 | ICD10CM | Covered |
| A02.0 | ICD10CM | Covered |
| A03.0 | ICD10CM | Covered |