Billing and Coding: MolDX: FDA-Approved BRAF Tests

FDA-approved BRAF V600 tests (cobas® 4800 and ThxID™ BRAF V600/K) are covered when used to detect BRAF V600 mutations in melanoma to determine eligibility for targeted therapies (vemurafenib for unresectable/metastatic BRAF V600 melanoma; dabrafenib for V600E; trametinib for V600E or V600K). Claims must use CPT 81210 with the appropriate DEX Z‑Code adjacent to the CPT code, include the correct ICD-10-CM diagnosis, and submitting laboratories must register the test on DEX and confirm unmodified kit use; NPI-to-ID editing will be applied.

"Perform cobas® 4800 BRAF V600 testing to detect BRAF V600 mutations in melanoma tissue to determine eligibility for vemurafenib (Zelboraf) in unresectable or metastatic melanoma."

Sign up to see full coverage criteria, indications, and limitations.