Change in Coverage for CPT Code 81493: Gene expression profiling – Coronary Artery Disease

Date Issued: 12/18/2018

Date Effective: 03/18/2019

CPT code 81493 – Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score, was previously covered for Medicare LOB (lines of business) only. Coverage determination was reversed for Medicare based on a Molecular Pathology Procedures LCD (L35000). With date of service on or after March 18, 2019, CPT code 81493 will no longer be covered for Medicare LOB and will be denied as Experimental and/or Investigational.