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

Limited germline testing for HRR genes (e.g., BRCA1/2) is covered when a patient with ovarian, breast, pancreatic, or prostate cancer meets clinical indication for immediate FDA‑approved PARP inhibitor therapy, has no prior germline or relevant somatic testing, and does not meet criteria for broader panel testing per LCD L39040. Claims must include the appropriate CPT code, one unit of service, the assigned DEX Z‑Code™ in the specified claim field or attachment, and at least one ICD‑10‑CM diagnosis code; medical records must document the clinical justification and prior testing history.

"Germline testing is covered when the patient has ovarian, breast, pancreatic, or prostate cancer and meets clinical indication for immediate treatment with an FDA‑approved PARP inhibitor."

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