Billing and Coding: Germline testing for use of PARP inhibitors

Germline testing limited to genes necessary to guide immediate, FDA‑approved PARP inhibitor therapy is covered when the patient is a candidate for such therapy, has no prior germline or somatic testing that already included the required genes, and does not meet criteria necessitating broader panel testing per LCD L38966. Billing requires the appropriate CPT code with one unit, inclusion of the DEX Z‑Code in specified Part A/Part B claim fields, and at least one ICD‑10‑CM diagnosis code.

"Patient meets clinical indication for immediate use of a PARP inhibitor for an FDA‑approved indication (examples: ovarian, breast, pancreatic, or prostate cancer)."

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