22-096 Rapid Whole Genome Sequencing Codes Are Now A Covered Benefit
Date: 02/04/22
This information applies to Physicians, Participating Physician Groups (PPGs) and Hospitals.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.
Find out which CPT codes are applicable
Rapid whole genome sequencing (rWGS) CPT codes 0094U, 0212U, 0213U, and 81425 thru 81427 are a covered benefit. This change is:
- Effective for dates of service on or after January 1, 2022, and
- For any Medi-Cal beneficiary who is 1 year of age or younger and is receiving inpatient hospital services in an intensive care unit.
These codes cannot be used for the purpose of inpatient billing; inpatient laboratory services are bundled under Diagnosis Related Group (DRG) or per diem payment.
CPT codes and descriptions
The following information provides CPT codes and their descriptions.
CPT codes | Description |
|---|---|
0094U | Genome (e.g., unexplained constitutional or heritable disorder or syndrome), rapid sequence analysis |
0212U | Rare diseases (constitutional/heritable disorders), whole genome and mitochondrial DNA sequence analysis, including small sequence changes, deletions, duplications, short tandem repeat gene expansions, and variants in non-uniquely mappable regions, blood or saliva, identification and categorization of genetic variants, proband |
0213U | Rare diseases (constitutional/heritable disorders), whole genome and mitochondrial DNA sequence analysis, including small sequence changes, deletions, duplications, short tandem repeat gene expansions, and variants in non-uniquely mappable regions, blood or saliva, identification and categorization of genetic variants, each comparator genome (e.g., parent, sibling) |
81425 | Genome (e.g., unexplained constitutional or heritable disorder or syndrome); sequence analysis |
81426 | Genome (e.g., unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genome (e.g., parents, siblings) |
81427 | Genome (e.g., unexplained constitutional or heritable disorder or syndrome); re-evaluation of previously obtained genome sequence (e.g., updated knowledge or unrelated condition/syndrome) |
Additional information
For more information on AB 133, refer to the Department of Health Care Services bulletin > section 6.
For all other questions, contact CalViva Health at 888-893-1569.