22-097 Rapid Whole Genome Sequencing Codes Are Now A Covered Benefit
Date: 02/04/22
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 one 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 California Health & Wellness Plan at 877-658-0305.