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

Coverage is allowed for limited germline testing of HRR genes (e.g., BRCA1/2) when the patient has an immediate clinical indication for an FDA‑approved PARP inhibitor (ovarian, breast, pancreatic, or prostate cancer), has no prior germline or relevant somatic testing that included the necessary genes, and does not meet criteria for broader germline panel testing per LCD L38972 or other guidelines. Claims must include an appropriate CPT code (one unit), a DEX Z‑Code adjacent to the CPT in the specified claim fields (Part A and B locations provided), and at least one ICD‑10‑CM diagnosis code; follow LCD L38972 for documentation of broader panel testing.

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

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