Why is a unique test identifier necessary?
Given the large and rapidly increasing number of molecular and genomic tests, many tests do not have unique procedure codes and are instead billed with non-specific procedure codes. The unique test identifier will provide additional information to distinguish the specific analyte tested to facilitate adjudication of claims.
What kinds of tests need a unique test identifier?
All tests billed with a non-specific procedure code as defined below must include a unique test identifier on the claim regardless of prior authorization requirement or determination outcome.
- Tier 2 codes: 81400-81408
- Unlisted/NOC codes used to bill molecular/genomic procedures: 81479, 81599, 84999
How do I get a unique test identifier?
A unique test identifier will be provided in the determination letter for each test that is billed with a non-specific procedure code.
Is this the same thing as a Z code?
No. The unique test identifier for the Tier 2 codes will generally be the claim designation codes published by the American Medical Association (AMA). eviCore will assign its own unique test identifier for unlisted codes and some special cases within the Tier 2 codes.
Where do I put this unique identifier on a claim form?
Most often, claims are submitted electronically, in which case the unique test identifier should be included in the 2400 SV101-7 field (Line Item Description) associated with the non-specific procedure code that is being billed. Refer to the full policy for guidance if institutional or paper claims will be submitted.
What happens if I don’t use the unique test identifier?
If you file a claim without including the unique test identifier, the claim may be denied and payment will be delayed.
Who do I call if I have questions?
You may call eviCore toll free at (844) 840-1199, Monday through Friday from 7:00 am to 7:00 pm in all time zones for assistance.