Genetic screening in the general population. Such testing is considered screening and is excluded by Medicare statute. An ABN must be obtained for BRCA1 and BRCA2 testing for individuals without signs and symptoms of breast, ovarian or other hereditary cancer syndromes as indicated in this LCD. Use this page to view details for the Local Coverage Article for Billing and Coding: Molecular Pathology Procedures. MolDX: Approved Gene Testing After a review of the current available literature, the MolDX Program has determined that testing for the following genes/gene components meets the Medicare criteria for a covered service. This listing has been updated with 2016 CPT codes. Patients who receive germline genetic testing for BRCA1 and BRCA2 (ideally within the context of a multigene panel) or who have genetic counseling completed within 6 months of diagnosis. Additionally, if photo testing is performed including application or patch testing, the code for photo patch testing (CPT code 95052) is to be reported, not CPT code 95044 (patch or application tests) and CPT code 95056 (photo tests). Allergy testing is covered when clinically significant symptoms exist and conservative therapy has failed. Use this page to view details for the Local Coverage Article for Billing and Coding: Biomarkers Overview. Use this page to view details for the Local Coverage Article for Billing and Coding: BRCA1 and BRCA2 Genetic Testing. The measure further specifies a population of patients with unknown Breast Cancer gene (BRCA) status. The panel acknowledges patients diagnosed with ovarian cancer may have undergone germline testing for a previous breast cancer diagnosis or that patients may have ovarian cancer identified at the time of prophylactic surgery following germline testing; patients with a known BRCA status at the. This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for BRCA1 and BRCA2 genetic testing services. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L36499, BRCA1 and BRCA2 Genetic Testing. Please refer to the LCD for reasonable and necessary requirements.