Cognitive Impairment/ Developmental Delay
□ Panel 1 (High resolution chromosome, 6.0 SNP microarray, Fragile X)
| PANEL 1 (HIGH RESOLUTION CHROMOSOMES, SNP MICROARRAY, FRAGILE X) | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81229, 81243. 88262, 88289, 88291, 88230, 88280, 88285 | 88230(1); 88262(1); 88280(1); 88285(1); 88289(1); 88291(1); 83891(1); 83892(3); 83898; 83898-91(2); 88386(1) | |
| HIGH RESOLUTION CHROMOSOMES | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 88230, 88262, 88280, 88285, 88289, 88291 | 88230(1);88262(1);88280(1);88285(1); 88289(1); 88291(1) | |
| SNP MICROARRAY | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81229 | 83891(1); 83892(3); 83898(2); 88386(1) | |
| FRAGILE X | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81243 | 83891(1);83894(1); 83898 (1); 83912-26(1) | |
□ Panel 2 (SYNGAP1, Tier A, XLID Tier 1, XLID Tier 2, XLID Tier 3, XLID Tier 4)
| PANEL 2 | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81406, 81405, 81404, 81302, 81406,81304, 81405, 81406, 81406, 81407, 81405, 81404, 81406, 81406, 81406, 81405, 81405, 81405, 81407, 81406, 81405, 81405, 81406, 81406, 81406, 81405, 81405, 81404, 81405, 81404, 81404, 81406, 81407, 81406, 81405, 81404 | 83891(1); 83892(1),83892-91(115); 83894(1),83894-91(73); 83898(1),83898-91(437); 83904(1),83904-91(786); 83909(1),83909-91(306); 83900(1); 83901(1),83901-91(26); 83908(1),83908-91(475);83912-26(1) | |
| SYNGAP1 | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81406 | 83891(1);83894(1);83898(20);83892(20);83904(40);83909(40);83912-26(1) | |
| XLID Tier A (NLGN3, NLGN4, MECP2, CDKL5) | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81405, 81404, 81302, 81406,81304, 81405 | 83891(1); 83894(1),83894-91(43); 83898(1),83898-91(86); 83904(1),83904-91(84); 83909(1),83909-91(80); 83900(1); 83901(1),83901-91(26); 83912-26(1) | |
| XLID Tier 1 (DLG3, FTSJ1, JARIDIC, PHF6, ZNF41) | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81406, 81406, 81407, 81405, 81404 | 83891(1); 83894(1), 83894-91(4); 83898, 83898-91(72); 83892; 83904, 83904-91(145); 83908(1), 83908-91(145);83912-26(1) | |
| XLID Tier 2 (GD11, FACL4, OPHN1, PQBP1, TM4SF2) | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81406, 81406, 81406, 81405, 81405, 81405 | 83891(1); 83894(1), 83894-91(4);83898(1), 83898-91(59);83892(1);83904, 83904-91(119);83908, 83908-91(119);83912-26(1) | |
| XLID Tier 3 (ATRX, FDG1, MID1, PLO 1, RSK2, SCL6A8) | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81407, 81406, 81405, 81405, 81406, 81406, 81406, 81405, 81405, 81404, 81405, 81404 | 83891(1);83894, 83894-91(10);83898, 83898-91(104);83892(1);83904, 83904-91(209);83908, 83908-91(209);83912-26(1) | |
| XLID Tier 4 (AFTR2, ARHGEF6, MED12, PAK3, SLC16A2 | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81404, 81406, 81407, 81406, 81405, 81404 | 83891(1);83894; 83894-91(7);83898; 83898-91(92);83892; 83892-91(92);83904; 83904-91(185);83909; 83909-91(185);83912-26(1) | |
Cognitive Impairment + Autism Spectrum Disorder
□ Panel 1 (High resolution chromosomes, 6.0 SNP microarray, Fragile X)
| PANEL 1 | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 88262, 88289, 88291, 81229, 81243, 88230, 88280, 88285 | 88230(1); 88262(1); 88280(1); 88285(1); 88289(1); 88291(1); 83891(1); 83892(3); 83898; 83898-91(2); 88386(1) | |
| HIGH RESOLUTION CHROMOSOMES | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 88230, 88262, 88280, 88285, 88289, 88291 | 88230(1);88262(1);88280(1);88285(1); 88289(1); 88291(1) | |
| SNP MICROARRAY | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81229 | 83891(1); 83892(3); 83898(2); 88386(1) | |
| FRAGILE X | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81243 | 83891(1);83894(1); 83898 (1); 83912-26(1) | |
□ Panel 2 (Angelman/ Angelman-like syndromes; XLID Tier A)
| PANEL 2 | |
| NEW UMBRELLA CODE | CPT CODE |
| 83891(1); 83892(1),83892-91(49); 83894(1),83894-91(46); 83898(1),83898-91(136); 83904(1),83904-91(182); 83909(1),83909-91(180); 83900(1); 83901(1),83901-91(26); 83896(86); 83912-26(1) | |
| ANGELMAN/ ANGELMAN-LIKE SYNDROMES (ANGELMAN METHYLATION, UBE3A, SLC9A6, TCF4) | |
| NEW UMBRELLA CODE | CPT CODE |
| 81331, 81406, 81406, 81406, 81405, 81405, 81404 | 83891(1); 83892,83892-91(49); 83894,83894-91(2); 83898,83898-91(49); 83904, 83904-91(97); 83909,83909-91(99); 83896(86); 83912-26(1) |
| XLID TIER A (NLGN3, NLGN4, MECP2, CDKL5) | |
| NEW UMBRELLA CODE | CPT CODE |
| 81405, 81404, 81302, 81406, 81304, 81405 | 83891(1); 83894(1),83894-91(43); 83898(1),83898-91(86); 83904(1),83904-91(84); 83909(1),83909-91(80); 83900(1); 83901(1),83901-91(26); 83912-26(1) |
Cognitive Impairment + Macrocephaly (OFC >2SD)
□ Panel (High resolution chromosomes, 6.0 SNP microarray, Fragile X, PTEN, RAB39B)
| PANEL | |
| NEW UMBRELLA CODE | CPT CODE |
| 81229, 81243, 81321, 81323, 81403, 81404, 88262, 88289, 88291, 88230, 88280, 88285 | 88230(1); 88262(1); 88280(1); 88285(1); 88289(1); 88291(1); 83891(1); 83892(1),83892-91(14); 83898(1),83898-91(14); 88386(1) |
| HIGH RESOLUTION CHROMOSOMES | |
| NEW UMBRELLA CODE | CPT CODE |
| 88230, 88262, 88280, 88285, 88289, 88291 | 88230(1);88262(1);88280(1);88285(1); 88289(1); 88291(1) |
| SNP MICROARRAY | |
| NEW UMBRELLA CODE | CPT CODE |
| 81229 | 83891(1); 83892(3); 83898(2); 88386(1) |
| FRAGILE X | |
| NEW UMBRELLA CODE | CPT CODE |
| 81243 | 83891(1);83894(1); 83898 (1); 83912-26(1) |
| PTEN | |
| NEW UMBRELLA CODE | CPT CODE |
| 81321, 81323, 81403 | 83891(1); 83892(9); 83894(1); 83898(9); 83904(18); 83909(18); 83912-26(1) |
| RAB39B | |
| NEW UMBRELLA CODE | CPT CODE |
| 81404 | 83891(1);83894(1);83898(3);83892(3);83904(6);83909(6);83912-26(1) |
Cognitive Impairment + Epilepsy
□ Panel 1 (High resolution chromosomes, 6.0 SNP microarray, RAB39B, Epilepsy Panel 1, Epilepsy Panel 2)
| PANEL | |||
| NEW UMBRELLA CODE | CPT CODE | ||
| 88230, 88262, 88280, 88285, 88289, 88291, 81229, 81404, 81406, 81406, 81404, 81302, 81406, 81304, 81405, 81405, 81406, 81406, 81406, 81403, 81404 | 88230(1); 88262(1); 88280(1); 88285(1); 88289(1); 88291(1); 83891(1); 83892(1),83892-91(89); 83898(1),83898-91(165); 88386(1) | ||
| HIGH RESOLUTION CHROMOSOME STUDY | |||
| NEW UMBRELLA CODE | CPT CODE | ||
| 88230, 88262, 88280, 88285, 88289, 88291 | 88230(1);88262(1);88280(1);88285(1); 88289(1); 88291(1) | ||
| SNP MICROARRAY | |||
| NEW UMBRELLA CODE | CPT CODE | ||
| 81229 | 83891(1); 83892(3); 83898(2); 88386(1) | ||
| RAB39B | |||
| NEW UMBRELLA CODE | CPT CODE | ||
| 81404 | 83891(1);83894(1);83898(3);83892(3);83904(6);83909(6);83912-26(1) | ||
| EPILEPSY PANEL 1 (SLC9A6, PCDHI9 (FEMALES ONLY), MECP2, CDKL5) | |||
| NEW UMBRELLA CODE | CPT CODE | ||
| 81406, 81406, 81404, 81302, 81406, 81304, 81405 | 83891(1);83894, 83894-91(34);83898, 83898-91(98);83892, 83892-91(22); 83904, 83904-91(94);83909, 83909-91(90); 83900(1); 83901(27);83912-26(1) | ||
| EPILEPSY PANEL 2 (ATP6AP2, SLC6A8, OPHN1, SYN1) | |||
| NEW UMBRELLA CODE | CPT CODE | ||
| 81405, 81406, 81406, 81406, 81403, 81404 | 83891(1);83894, 83894-91(6);83898, 83898-91(60);83892, 83892-91(60);83904, 83904-91(121);83909, 83909-91(121);83912-26(1) | ||
□ Panel 2 (SYNGAP 1, MELAS, Angelman/ Angelman-like syndromes)
| PANEL 2 | |
| NEW UMBRELLA CODE | CPT CODE |
| 81401, 81331, 81406, 81406, 81406, 81405, 81405, 81404 | 83891(1); 83892,83892-91(50); 83894,83894-91(3); 83898,83898-91(50); 83904, 83904-91(97); 83909,83909-91(99); 83896(86); 83912-26(1) |
| SYNGAP1 | |
| NEW UMBRELLA CODE | CPT CODE |
| 81406 | 83891(1);83894(1);83898(20);83892(20);83904(40);83909(40);83912-26(1) |
| MELAS | |
| NEW UMBRELLA CODE | CPT CODE |
| 81401 | 83891(1);83892(1);83894(1);83898(1);83912-26(1) |
| ANGELMAN/ ANGELMAN-LIKE SYNDROMES (ANGELMAN METHYLATION, UBE3A, SLC9A6, TCF4) | |
| NEW UMBRELLA CODE | CPT CODE |
| 81331, 81406, 81406, 81406, 81405, 81405, 81404 | 83891(1); 83892,83892-91(49); 83894,83894-91(2); 83898,83898-91(49); 83904, 83904-91(97); 83909,83909-91(99); 83896(86); 83912-26(1) |
Autism Spectrum Disorder
□ Panel 1(High resolution chromosomes, 6.0 SNP microarray, Fragile X, MECP2, NLGN3, NLGN4)
| PANEL | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 88230, 88280, 88285, 88262, 88289, 88291, 81229, 81243, 81302, 81304, 81405, 81404 | 88230(1); 88262(1); 88280(1); 88285(1); 88289(1); 88291(1); 83891(1); 83892(3); 83898, 83898-91(13); 83901(27); 88386(1) | |
| HIGH RESOLUTION CHROMOSOME STUDY | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 88230, 88262, 88280, 88285, 88289, 88291 | 88230(1);88262(1);88280(1);88285(1); 88289(1); 88291(1) | |
| SNP MICROARRAY | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81229 | 83891(1); 83892(3); 83898(2); 88386(1) | |
| FRAGILE X | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81243 | 83891(1);83894(1); 83898 (1); 83912-26(1) | |
| MECP2 | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81302, 81304 | 83891(1); 83894(11); 83898(10); 83900(1); 83901(27); 83904(5); 83909(1); 83912-26(1) | |
| NLGN3 & NLGN4X | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81302, 81304 | 83891, 83894, 83894-91(10); 83898, 83898-91(10); 83904, 83904-91(35); 83909, 83909-91(35); 83912-26(1) | |
□ Panel 2 (SYNGAP1, PTCHD1, GDI1)
| SYNGAP1 | |
| NEW UMBRELLA CODE | CPT CODE |
| 81406 | 83891(1);83894(1);83898(20);83892(20);83904(40);83909(40);83912-26(1) |
| PTCHD1 | |
| NEW UMBRELLA CODE | CPT CODE |
| 81404, 81403 | 83891(1);83894(1);83896(20);83898,83898-91(14);83892(14);83904(28);83909,83909-91(28);83912-26(1);83914(1) |
| GDI1 | |
| NEW UMBRELLA CODE | CPT CODE |
| 81406, 81403 | 83891(1);83892(11);83894(1);83898(11);83904(22);83909(22);83912-26(1) |
Autism Spectrum Disorder + Macrocephaly (OFC >2SD)
□ Panel 1 (High resolution chromosomes, 6.0 SNP microarray, Fragile X, PTEN)
| PANEL | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 88230, 88280, 88285, 88262, 88289, 88291, 81321, 81323, 81229, 81243, 81403 | 88230(1); 88262(1); 88280(1); 88285(1); 88289(1); 88291(1); 83891(1); 83892(1),83892-91(11); 83898(1),83898-91(11); 88386(1 | |
| HIGH RESOLUTION CHROMOSOMES | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 88230, 88262, 88280, 88285, 88289, 88291 | 88230(1);88262(1);88280(1);88285(1); 88289(1); 88291(1) | |
| SNP MICROARRAY | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81229 | 83891(1); 83892(3); 83898(2); 88386(1) | |
| FRAGILE X | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81243 | 83891(1);83894(1); 83898 (1); 83912-26(1) | |
| PTEN | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81321, 81323, 81403 | 83891(1); 83892(9); 83894(1); 83898(9); 83904(18); 83909(18); 83912-26(1) | |
□ Panel 2 (NSD1, RAB39B)
| PANEL | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81406, 81405, 81404 | 83891(1); 83892(1),83892-91(39); 83894(1),83894-91(2); 83898(1),83898-91(39); 83904(1),83904-91(79); 83909(1),83909-91(79); 83912-26(1) | |
| NSD1 | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81406, 81405 | 83891(1);83892(37);83894(2);83898(37);83904(74);83909(74);83912-26(1) | |
| RAB39B | ||
| NEW UMBRELLA CODE | CPT CODE | |
| 81404 | 83891(1);83894(1);83898(3);83892(3);83904(6);83909(6);83912-26(1) | |
Cognitive Impairment (Nonverbal) OR Autism Spectrum Disorder + Microcephaly (OFC <2SD)
□ Panel [High resolution chromosomes, 6.0 SNP microarray, Angelman/ Angelman-like syndrome panel, Rett (Classic, Atypical, Congenital variants)/ Rett-like syndromes panel]
| PANEL | |
| NEW UMBRELLA CODE | CPT CODE |
| 88262, 88289, 88291, 81229, 81302, 81304, 88230, 88280, 88285,81331, 81406, 81406, 81406, 81405, 81405, 81404, 81302, 81304, 81406, 81405, 81404, 81402 | 88230(1); 88262(1); 88280(1); 88285(1); 88289(1); 88291(1); 83891(1); 83892,83892-91(74); 83898,83898-91(149); 83900(1); 83901(27); 88386(1) |
| HIGH RESOLUTION CHROMOSOMES | |
| NEW UMBRELLA CODE | CPT CODE |
| 88230, 88262, 88280, 88285, 88289, 88291 | 88230(1);88262(1);88280(1);88285(1); 88289(1); 88291(1) |
| SNP MICROARRAY | |
| NEW UMBRELLA CODE | CPT CODE |
| 81229 | 83891(1); 83892(3); 83898(2); 88386(1) |
| ANGELMAN/ ANGELMAN-LIKE SYNDROMES (ANGELMAN METHYLATION, UBE3A, SLC9A6, TCF4) | |
| NEW UMBRELLA CODE | CPT CODE |
| 81331, 81406, 81406, 81406, 81405, 81405, 81404 | 83891(1); 83892,83892-91(49); 83894,83894-91(2); 83898,83898-91(49); 83904, 83904-91(97); 83909,83909-91(99); 83896(86); 83912-26(1) |
| RETT (CLASSIC, ATYPICAL, CONGENITAL VARIENTS)/ RETT-LIKE SYNDROMES PANEL (MECP2, CDKL5, FOXG1, TCF4) | |
| NEW UMBRELLA CODE | CPT CODE |
| 81302, 81304, 81406, 81405, 81404, 81402, 81406, 81405 | 83891(1); 83894,83894-91(34); 83898,83898-91(97); 83892,83892-91(21); 83900(1); 83901(27); 83904,83904-91(92); 83909,83909-91(88); 83912-26(1) |
| MECP2 (SEQUENCING AND MLPA) | |
| NEW UMBRELLA CODE | CPT CODE |
| 81302, 81304 | 83891(1); 83894(11); 83898(10); 83900(1); 83901(27); 83904(5); 83909(1); 83912-26(1) |
| CDKL5 | |
| NEW UMBRELLA CODE | CPT CODE |
| 81406, 81405 | 83891(1);83894(22);83898(66);83904(44);83909(44);83912-26(1) |
| FOXG1 | |
| NEW UMBRELLA CODE | CPT CODE |
| 81404, 81402 | 83891(1);83894(1);83898(4);83892(4);83904(8);83909(8);83912-26(1) |
| TCF4 | |
| NEW UMBRELLA CODE | CPT CODE |
| 81406, 81405 | 83891(1);83894(1);83898(18);83892(18);83904(36);83909(36);83912-26(1) |
| ZEB2 | |
| NEW UMBRELLA CODE | CPT CODE |
| 81405, 81404 | 83891(1);83896(37);83894(1);83898(1),83898-91(16); 83892(16); 83904(32); 83909(1),83909-91(32); 83912-26(1); 83914(1) |
| SNP CHIP and Rett Panel when Blood Chrom or High Res and FX were previously billed | |
| NEW UMBRELLA CODE | CPT CODE |
| 81302, 81304, 81406, 81405, 81404, 81406, 81405, 81402, 81229 | 83898,83898-91(99); 83892,83892-91(24); 83900(1); 83901(27); 88386(1) |