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

Limited germline testing for HRR genes (e.g., BRCA1/2) may be billed to support immediate FDA‑approved PARP inhibitor use in patients with ovarian, breast, pancreatic, or prostate cancer when the patient has had no prior germline or somatic testing that included the necessary genes and does not meet L38974 criteria requiring comprehensive testing. Claims must include the appropriate CPT with one unit, a DEX Z‑Code entered in the specified claim fields, and at least one ICD‑10‑CM diagnosis code; medical records must document the clinical need and prior testing status.

"Patient with ovarian, breast, pancreatic, or prostate cancer who meets the clinical indication for immediate use of an FDA‑approved PARP inhibitor."

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