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

This policy permits billing for tumor-targeted NGS panels and Comprehensive Genomic Profile (CGP) tests for cancer when the assays identify clinically actionable somatic alterations to guide diagnosis, targeted therapy selection, prognosis, or trial/off-label treatment options. Providers must report tests with the approved DEX Z‑Code and appropriate CPT codes (e.g., 81445/81450 for DNA-targeted panels; 81459 or 81479 for CGP or NOC services), observe UOS=1, and note that CGP coverage is limited to one test per surgical specimen and precludes further molecular testing on that specimen.

"Targeted tumor NGS panels are covered for tumor-based somatic variant detection when used to identify hotspot alterations (SNVs, small INDELs, single-site CNVs, or gene fusions) required for cancer..."

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