Summary & Overview
HCPCS S3852: APOE Epsilon 4 Allele DNA Analysis for Alzheimer Susceptibility
HCPCS Level II code S3852 denotes DNA analysis for the APOE epsilon 4 allele to assess susceptibility to Alzheimer’s disease. This molecular diagnostic identifies presence of the APOE ε4 allele, which is associated with increased risk of late-onset Alzheimer’s and can inform clinical discussions on risk stratification and genetic counseling. Nationally, availability and coverage of APOE testing affects access to genetic risk information and downstream clinical services.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the test, expected sites of service (clinical laboratories and outpatient genetic testing facilities), and payer context. The publication provides benchmarks and policy summaries where available, clarifies coding and billing considerations tied to this HCPCS Level II code, and outlines clinical context relevant to ordering clinicians and billing staff.
The summary highlights implications for utilization management, preauthorization practices, and the role of genetic counseling when reporting susceptibility testing. Data not available in the input are identified where applicable, and the piece is intended as a national overview of code S3852 for stakeholders involved in molecular diagnostics, billing, and policy.
Billing Code Overview
HCPCS Level II code S3852 describes DNA analysis for the APOE epsilon 4 allele used to assess susceptibility to Alzheimer’s disease. The service is a genetic susceptibility test that identifies presence of the APOE ε4 allele, a known genetic factor associated with increased risk of late-onset Alzheimer’s disease.
Service Type: Genetic testing / Molecular diagnostic
Typical Site of Service: Clinical laboratory or outpatient genetic testing facility
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with progressive short-term memory decline and a strong family history of Alzheimer disease presents to a neurology clinic. After cognitive screening and neuropsychological testing showing mild cognitive impairment, the neurologist discusses genetic testing for the apolipoprotein E (APOE) genotype to assess susceptibility to Alzheimer disease, specifically testing for the APOE ε4 allele using DNA analysis billed with S3852. A signed informed consent and genetic counseling session are completed by a board-certified genetic counselor or the ordering neurologist before specimen collection. A peripheral blood draw or buccal swab is performed in the outpatient clinic or an accredited laboratory, with the sample sent to a CLIA-certified molecular diagnostics laboratory. Results are returned to the ordering clinician and genetic counselor, documented in the medical record, and used to inform risk discussion, research eligibility, and potential care planning. Typical sites of service include outpatient physician offices, outpatient phlebotomy collection centers, and independent clinical laboratories. Clinical workflow steps: pre-test counseling and consent; specimen collection (blood or buccal swab); laboratory DNA extraction and targeted genotyping for APOE ε4; result reporting and post-test counseling; documentation of results and any subsequent referrals (clinical genetics, neurology follow-up, research enrollment).
Coding Specifications
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