Billing and Coding: MolDX: cobas® EGFR Mutation Test Guidelines

Effective for dates of service on and after 5/14/13, CGS Administrators and the MolDX program contractor will cover the FDA approved, cobas EGFR Mutation Test for the detection of epidermal growth factor receptor (EGFR) gene for non-small cell lung cancer (NSCLC) tumor tissue. The test is intended to be used to help select patients with NSCLC for whom Tarceva® (erlotinib), an EGFR tyrosine kinase inhibitor (TKI), is indicated. To report a cobas service, please submit the following claim information: CPT code 81479 – Unlisted chemistry procedure Enter “ZBA66” in the comment/narrative field for the following claim field/types: Loop 2300 NTE01 for part A or Loop 2400 NTE02/SV 101-7 for Part B Submit “ZBA66” on an attachment to the claim form for paper claim(Form locator 80 fro Part A or Box 19 for Part B) Select at least one ICD-10-CM diagnosis code from the following tables for dates of service on and after 10/01/2015 C34.11 Malignant neoplasm of upper lobe, right bronchus or lung C34.12 Malignant neoplasm of upper lobe, left bronchus or lung C34.2 Malignant neoplasm of middle lobe, bronchus or lung C34.31-Malignant neoplasm of lower lobe, right bronchus or lung C34.32-Malignant neoplasm of lower lobe, left bronchus or lung C34.81-Malignant neoplasm of overlapping sites of right bronchus and lung C34.82-Malignant neoplasm of overlapping sites of left bronchus and lung C34.91-Malignant neoplasm of unspecified part of right bronchus or lung C34.92-Malignant neoplasm of unspecified part of left bronchus or lung NOTE: CGS and the MolDX Program contractor will apply NPI to ID editing. All labs that submit claims for the cobas EGFR kit MUST register the test and confirm the UNMODIFIED use of the kit. For lab developed tests (LDT) or tests that modify the cobas EGFR kit, CPT code 81235 should be reported and submitted with the assigned LDT test ID.