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FACA Mtg. ItemALM Code List Item #Code #Code TypeCategorySorterLong Code DescriptorComment. Panel RecommendationCMS 2022 Preliminary RecommendationRationaleGenesPrice
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10708X000NEWGenomic Sequencing Related Tests TARGETED Drug metabolism pharmacogenomics/pharmcogenetics1Drug metabolism (eg, pharmacogenomics) genomic sequence analysis panel, must include testing of at least 6 genes, including CYP2C19, CYP2D6, and CYP2D6 duplication/deletion analysisThis is the generic AMA CPT PGX code, 6 or more genes.Crosswalk to 81225 + 0070U: 1
Crosswalk to 81435 + 81436: 0
Crosswalk to 81413 + 81414: 0
Gapfill: 11
Abstain: 0
Crosswalk to 0029U $742. (Mayo panel)CMS disagrees with the Panel Recommendation and instead is recommending a crosswalk. The crosswalked code(s) appear to use similar methods and resource utilization.6 plus$742
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12970X47UPLAGenomic Sequencing Related Tests TARGETED Drug metabolism pharmacogenomics/pharmcogenetics2Psychiatry (eg, depression, anxiety, attention deficit hyperactivity disorder [ADHD]), genomic analysis panel, variant analysis of 15 genes, including deletion/duplication analysis of CYP2D60345U, GeneSight, Psychotropic, MYRIADCrosswalk to 0175U: 12
Gapfill: 0
Abstain: 0		Crosswalk 0175U, Genomind Psych Panel, 15 Genes, $1336.CMS agrees with the majority CDLT Panel recommendation to crosswalk the code. The crosswalked code(s) appear to use similar methods and resource utilization.15$1,336
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141000X51UPLAGenomic Sequencing Related Tests TARGETED Drug metabolism pharmacogenomics/pharmcogenetics3Drug metabolism or processing (multiple conditions), whole blood or buccal specimen, DNA analysis, 16 gene report, with variant analysis and reported phenotypes0347U, Right med PGX 16, OneOME LLCCrosswalk to 0175U: 12
Gapfill: 0
Abstain: 0		Crosswalk 0175U, Genomind Psych Panel, 15 Genes, $1336.CMS agrees with the majority CDLT Panel recommendation to crosswalk the code. The crosswalked code(s) appear to use similar methods and resource utilization.16$1,336
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13990X50UPLAGenomic Sequencing Related Tests TARGETED Drug metabolism pharmacogenomics/pharmcogenetics4Drug metabolism or processing (multiple conditions), whole blood or buccal specimen, DNA analysis, 25 gene report, with variant analysis and reported phenotypes0348U, Right med, Comprehensive, EXCLUDE F2 F5, OneOme LLCGapfill: 12
Abstain: 0		Crosswalk to 0029U $742. (Mayo panel)CMS disagrees with the Panel Recommendation and instead is recommending a crosswalk. The crosswalked code(s) appear to use similar methods and resource utilization.25$742
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11950X45UPLAGenomic Sequencing Related Tests TARGETED Drug metabolism pharmacogenomics/pharmcogenetics5Drug metabolism or processing (multiple conditions), whole blood or buccal specimen, DNA analysis, 27 gene report, with variant analysis including reported phenotypes and impacted gene-drug interactions0349U, RightMed Comprehensive OneOME LLCGapfill: 12
Abstain: 0		Crosswalk to 0029U $742. (Mayo panel)CMS disagrees with the Panel Recommendation and instead is recommending a crosswalk. The crosswalked code(s) appear to use similar methods and resource utilization.27$742
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151010X52UPLAGenomic Sequencing Related Tests TARGETED Drug metabolism pharmacogenomics/pharmcogenetics6Drug metabolism or processing (multiple conditions), whole blood or buccal specimen, DNA analysis, 27 gene report, with variant analysis and reported phenotypes - [w/o gene drug interactions]0350U, RIGHT MED GENE REPORT, OneOME LLCCrosswalk to 0175U: 4
Gapfill: 8
Abstain: 0		Crosswalk 0175U, Genomind Psych Panel, 15 Genes, $1336.CMS agrees with the minority CDLT Panel recommendation to crosswalk the code. The crosswalked code(s) appear to use similar methods and resource utilization.27$1,336
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1620286UPLAGenomic Sequencing Related Tests TARGETED Drug metabolism pharmacogenomics/pharmcogenetics7CEP72 (centrosomal protein, 72-KDa), NUDT15 (nudix hydrolase 15) and TPMT (thiopurine S-methyltransferase) (eg, drug metabolism) gene analysis, common variants

Unusual 3 gene PGX test, RPRD Diagnostics. Milwaukee.Gapfill: 12
Abstain: 0		Crosswalk to 0030U. Mayo warfarin response. $134.CMS disagrees with the Panel Recommendation and instead is recommending a crosswalk. The crosswalked code(s) appear to use similar methods and resource utilization.3$134
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