Summary & Overview
HCPCS Level II S3842: Genetic Testing for von Hippel-Lindau Disease
HCPCS Level II code S3842 represents genetic testing for von Hippel-Lindau (VHL) disease, a hereditary cancer syndrome caused by pathogenic variants in the VHL gene. Nationally, access to diagnostic genetic testing is important for risk stratification, targeted surveillance, and family planning for affected individuals and at-risk relatives. Coverage policies and coding clarity for this service influence clinical workflows, laboratory billing, and patient access.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage landscape and billing considerations, clinically relevant context for when VHL testing is indicated, and operational benchmarks relevant to laboratory and outpatient genetic services. The publication outlines payer-specific coverage themes and common modifier usage patterns, highlights policy updates affecting molecular diagnostics reimbursement, and summarizes implications for clinicians and billing teams. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code S3842 denotes genetic testing for von Hippel-Lindau disease. This service involves molecular diagnostic testing to identify pathogenic variants in the VHL gene associated with von Hippel-Lindau syndrome.
Service Type: Genetic testing and molecular diagnostic analysis.
Typical Site of Service: Clinical laboratory or outpatient genetic testing facility.
Clinical & Coding Specifications
Clinical Context
A 32-year-old adult with a family history of von Hippel-Lindau (VHL) disease is referred by a genetics clinic for targeted germline molecular testing. The patient has a first-degree relative with genetically confirmed VHL and presents with a history of recurrent retinal hemangioblastomas and a newly identified pancreatic cyst on surveillance imaging. Pre-test genetic counseling is completed by a board-certified genetic counselor or clinical geneticist; informed consent is documented. A blood specimen is collected in an outpatient phlebotomy setting or clinic and sent to a reference molecular laboratory. The laboratory performs sequencing and deletion/duplication analysis of the VHL gene. Results are reported to the ordering provider and discussed in a follow-up visit with the genetics team to guide surveillance for renal cell carcinoma, CNS hemangioblastomas, pheochromocytoma screening, and family cascade testing. Typical sites of service include outpatient genetics clinics, ambulatory specialty clinics, and independent molecular diagnostic laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician or professional interpretation component of the laboratory result in settings where technical and professional components are billed separately. |
TC |