← Return to FSHD1 and FSHD2 Billing Directives
On the FSHD1 and FSHD2 Requisition:
Select one of the following billing options:
- Direct Bill - Referring Institution (Client), or
- Process and Hold Specimen until Referring Institution Completes Vetting Insurance Coverage – Referring Institution (Client)
Download the FSHD1 and FSHD2 Requisition
Applicable CPT codes and client 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 |
| 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 subject to change | ||
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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.
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Note, there will always be one professional charge irrespective of what test is ordered.
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An order for a full panel may not require performance of all the components, and the UIDL will only bill for the work performed.
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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.
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In general, the minimum amount of testing performed is optical mapping to determine allele sizes and haplotyping.
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Please refer to FSHD diagnostic workflow for more detail.