Wisconsin Physicians Service issues new LCD policy for narcolepsy testing

The Wisconsin Physicians Service Insurance Corporation (WPS) has issued a new local coverage determination (LCD) policy (L37003) that provides new coverage information related to narcolepsy testing. According to the LCD, HLA-DQB1*06:02 typing, a DNA test used in the diagnosis of narcolepsy, is considered an experimental/investigational procedure that is unproven for all populations.

The CPT code for HLA-DQB1*06:02 typing is 81383, and its description is “HLA Class II typing, high resolution (ie, alleles or allele groups); one allele or allele group (e.g., HLA-DQB1*06:02P), each.” The LCD states, “Although research suggests a strong association between HLA-DQB1*06:02 and narcolepsy risk, HLA-DQB1*06:02 typing is insufficient to confirm a diagnosis of narcolepsy, rule out a diagnosis of narcolepsy or quantify risk for narcolepsy.”

Therefore, HLA-DQB1*06:02 typing will not be a covered service upon implementation of the LCD, which will apply to services performed on or after July 17, 2017. Medicare Part B providers in the states of Iowa, Kansas, Missouri, Nebraska, Indiana, and Michigan are included in the WPS jurisdictions to which the LCD applies.

According to the International Classification of Sleep Disorders, Third Edition, “HLA typing of narcoleptic patients with cataplexy almost always shows the presence of HLA DQB1*0602 (and DR2 or DRB1*1501 in whites and Asians), but this is not diagnostic for narcolepsy. Approximately 25% of the normal Caucasian population, 12% of the Japanese population, and 38% of the black population are positive for
DQB1*0602.”

Comments about WPS policies can be submitted to policycomments@wpsic.com. If you have questions about coverage policies, you can contact the AASM at coding@aasm.org. Answers to frequently asked questions are available on the Coding FAQs page on the AASM website.

2017-06-30T00:00:00+00:00 June 30th, 2017|Clinical Resources|