Avalere Health
An Inovalon Company
Insights

Mar 11, 2014

New CPT Codes for Next Generation Sequencing Procedures on the Horizon for 2015

Published

Mar 11, 2014

The American Medical Association’s (AMA) Current Procedural Terminology (CPT®) Editorial Panel (Panel) announced on March 5 its acceptance of a set of codes that will be used to report testing for large-scale, multianalyte genomic sequencing procedures typically performed using Next Generation Sequencing (NGS) technology.

The Panel’s Molecular Pathology Workgroup published slides that reviewed the basics of what was presented at the February 2014 Panel meeting.

The codes and their descriptors are not finalized until just prior to publication of the CPT code set, so they may be subject to future revisions by the Panel. The final code numbers and descriptors will be published with the CPT coding files in late August and will become effective Jan. 1, 2015.

The codes accepted will focus on parallel genetic sequencing for genes and mutations associated with a specific set of conditions, as well as whole exome and whole genome sequencing. These include:

The codes accepted will focus on parallel genetic sequencing for genes and mutations associated with a specific set of conditions, as well as whole exome and whole genome sequencing. These include:

  • Aortic dysfunction These codes will allow for uniform reporting of broad genomic testing panels using NGS technologies. While these codes will standardize reporting for NGS testing, they do not guarantee coverage and/or reimbursement for these tests, which will still need to prove clinical utility. Providers testing for individual or a small number of targeted genes or mutations, such as those used in today’s companion diagnostics, will likely still report these procedures using the Tier 1 and Tier 2 molecular pathology codes, even if performed using NGS technology.     

  • Colon cancer panel
  • Nonsyndromic hearing loss
  • X-linked intellectual disability
  • Fetal aneuploidy
  • Whole mitochondrial genome
  • Targeted neoplasm somatic mutations (solid organ and hematolymphoid)
  • Whole exome and whole genome
Back to Results
« Back to Mobile Site