Palmetto GBA has completed the Afirma assessment and determined that the test meets criteria for analytical and clinical validity, and clinical utility as a reasonable and necessary Medicare benefit. Effective 01/01/12, Palmetto GBA will reimburse Afirma services for patients with the following conditions:
Patients with one or more thyroid nodules with a history or characteristics suggesting malignancy such as:
Nodule growth over time
Family history of thyroid cancer
Hoarseness, difficulty swallowing or breathing
History of exposure to ionizing radiation
Hard nodule compared with rest of gland consistency
Presence of cervical adenopathy
Have an indeterminate follicular pathology on fine needle aspiration
Palmetto GBA expects this test will be performed once per patient lifetime. Should the unlikely situation of a second, unrelated thyroid nodule with indeterminate pathology occur, coverage may be considered upon appeal with support documentation.
To report an Afirma service, please submit the following claim information:
CPT code 84999 - unlisted chemistry procedure
Select the appropriate diagnosis from the following ICD-9 codes:
241.0 - nontoxic uninodular goiter
241.1 - nontoxic multinodular goiter
Enter "ZB846" in the comment/narrative field for the following claim field/types:
Loop 2400, NTE02, or SV101-7 for the 5010A1 837P
Submit "ZB846" on an attachment to the claim form for paper claim
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