← Return to FSHD1 and FSHD2 Billing Directives
On the FSHD1 and FSHD2 Requisition:
Select the following billing option:
-
Direct Bill – Patient (Self-Pay)
No prepayment required. The UIDL will issue the guarantor a statement of charges.
Download the FSHD1 and FSHD2 Requisition
Applicable CPT codes and self-pay rate for the FSHD panel and individual panel components:
| Test Order | CPT | Maximum Charge |
|---|---|---|
|
FSHD1 and FSHD2 Panel |
Technical: 81404 (x1) Professional: G0452 (x1) |
$2,600.00 |
| Component | CPT | Total Charges |
|
Optical Mapping (allele size and haplotyping) |
Technical: 81404 (x1) Professional: G0452 (x1) |
$1,300.00 |
|
Methylation |
Technical: 81479 (x1) Professional: G0452 (x1) |
$714.00 |
|
NGS (SMCHD1, LRIF1, DNMT3B) |
Technical: 81479 (x1) Professional: G0452 (x1) |
$714.00 |
|
Pricing is subject to change. |
||
- An order for the full FSHD1 and FSHD2 panel is not required; providers must be specific on the UIDL FSHD Test Requisition whether the full panel or individual components are requested.
- Note, there will always be one professional charge irrespective of what test is ordered.
- An order for a full panel may not require performance of all the components, and the UIDL will only bill for the work performed.
- Please know that the amount of testing that will ultimately be performed on a specimen when an order for the full panel is requested cannot be determined prior to the start of the testing.
- In general, the minimum amount of testing performed is optical mapping to determine allele sizes and haplotyping.
The minimum amount of testing that will generally be done, is the Determination of Allele Sizes and Haplotyping by Optical Mapping.
Please refer to FSHD diagnostic workflow for more detail.