Billing and Coding: MolDX: Germline testing for use of PARP inhibitors

Coverage is allowed for limited germline testing to inform immediate PARP inhibitor therapy when the patient has an FDA‑approved PARP indication (commonly ovarian, breast, pancreatic, or prostate cancer), has no prior germline or somatic testing that included the required genes, and does not meet criteria for broader germline testing per LCD L38966. Claims must include the appropriate CPT code (one unit), the DEX Z‑Code entered adjacent to the CPT code per Part A/Part B claim instructions, and at least one ICD‑10‑CM diagnosis code. Tests are not covered if prior testing already included the necessary genes, if broader germline testing is indicated per L38966, or for non‑FDA PARP uses.

"Patient meets clinical indication for immediate use of a PARP inhibitor for an FDA‑approved indication (e."

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