Billing and Coding: MolDX: PIK3CA Gene Tests

PIK3CA targeted gene sequencing is covered when used to detect PIK3CA mutations in postmenopausal women and men with HR-positive, HER2-negative advanced or metastatic breast cancer after progression on or after an endocrine regimen, and tests must be FDA-approved for this purpose. Claims must include the appropriate CPT and diagnosis codes and must place the DEX Z-Code™ identifier adjacent to the CPT code in the specified Part A and Part B claim fields; coverage effective for dates of service on or after May 24, 2019.

"PIK3CA targeted gene sequencing is covered when performed to detect PIK3CA mutations in patients who are postmenopausal women or men with hormone receptor (HR)-positive, HER2-negative advanced or m..."

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