Cardiology Coding Alert

Question: Are there coverage limitations for the Corus CAD test?

Texas Subscriber

Answer: Texas Part B MAC Novitas states that “The CORUS® CAD test will be considered reasonable and necessary for patients with stable symptoms that have a history of chest pain, suspected anginal equivalent to chest pain, or a high risk of CAD, but no known prior myocardial infarction or revascularization procedures” (LCD L36713). The LCD includes a list of supporting ICD-10 codes.

Keep in mind that the lab performing the test will report 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). The cardiologist will most likely include the review and consideration of the test results when choosing a visit’s E/M level.

Caution: There are some limitations to watch for, so be sure to review the complete LCD to fully understand coverage rules.

Example: Novitas won’t consider the test reasonable and necessary for patients on steroids, immunosuppressive agents, or chemotherapeutic agents, among other limitations. The test is also covered only once per beneficiary lifetime.