Thursday, November 2, 2017

MOLDX MoPath Tier 2 Fee Schedule, M00005, V10, June 23, 2017

2017 MoPath Tier 2 Fee Schedule (M00005, V10)

The table below lists the fees established for Tier 2 covered tests. Please note the genes are sorted by CPT code and then by alpha per gene. Multiple genes are listed under a single CPT Tier 2 code. The required DEX Z-code™ assigned and submitted with each test enables MolDX to apply the appropriate fee for the specific test performed.
CPT Code
Descriptor
Allowed
81400
ACE, idv
$82.58
81400
F13B, V34L
$64.52
81400
F2, 1199G>A
$70.20
81400
F5, HR2
$58.84
81400
F7, R353Q
$64.52
81400
FGB, -455G>A
$70.20
81400
HPA, antigen ea
$46.46
81400
HPA, panel
$185.84
81400
IL28B
$55.23
81400
IL28B, rs12979860
$55.23
81400
SERPINE1, 4G
$58.84
81401
ABL1, T315I
$153.01
81401
CYFB_MYH11, cv
$138.82 
81401
CCND1_IGH, ta majbp qual qual
$93.94
81401
EML4_ALK, ta or ia
$128.48
81401
EWSR1_WT1, ta qual quan
$203.84
81401
F11, cv
$75.88
81401
FIP1L1_PDGFR, qual quan
$90.82
81401
FOXO1_PAX3, ta, qual quan
$120.75
81401
FOXO1_PAX7, ta, qual quan
$120.75
81401
IGH/BCL2, sbp 
$123.36 
81401
MUTYH, cv
$105.81
81401
PAX8_PPARG, ta
$54.19
81401
RUNX1_RUNX1T1, ta qual quan
$106.05
81401
TPMT, cv
$111.61
81401
TYMS, trv
$169.10
81401
VWF, cv
$278.18
81401
IGH_BCL2, sbp
$123.36
81402
KIT, cv
$98.13
81402
MPL, cv
$89.04
81403
EPCAM, kfv
$93.94
81403
F8, intron 1 and 22a
$81.05
81403
IDH1, exon 4
$67.70
81403
IDH2, exon 4
$67.70
81403
JAK2, exon 12 and 13
$109.14
81403
MUTYH, kfv 
$93.94 
81403
VHL , dup_del
$83.60
81403
VWF, tsa
$300.03
81403
CDKN2A, kfv
$93.94
81404
CDKN2A, fgs
$373.14
81404
NRAS, exon 1, 2
$148.04
81404
PRSS1, fgs
$248.76
81404
RET, cv
$94.97
81404
VHL, fgs
$639.96
81405
MEN1, fgs
$426.32
81405 
RET, tsa 
$379.47 
81405
VWF, tsa 2N
$278.18
81406
RET, fgs
$384.51

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