Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile Testing in Cancer

This MolDX billing policy defines targeted tumor panels and comprehensive genomic profile (CGP) testing and prescribes appropriate CPT coding: DNA-based targeted panels (81445/81450) and CGP (81459 or 81479) with NOC use of 81479 for tests not fitting definitions. Claims must include the approved DEX Z-Code and observe unit-of-service limits (UOS=1); CGP coverage is limited to one test per surgical specimen and individual biomarker CPT codes must not be used when testing is performed as part of NGS or other multiplex panels.

"DNA-based targeted tumor panels that measure specific SNVs, small INDELs, single-site CNVs, or rearrangements and meet policy coverage requirements may be billed with CPT 81445 or 81450."

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