Billing and Coding: MolDX: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268)
A55621
MolDX covers STR marker chimerism testing for recipient/donor testing and post-transplant monitoring: CPT 81265 for recipient/donor testing (report 1 UOS, typically once per lifetime), CPT 81266 for an additional double-cord blood sample in bone marrow transplants, CPT 81267 for post-transplant pre/post comparisons, and CPT 81268 for buccal/germline tissue testing post-transplant. Twin zygosity testing is statutorily excluded and will be denied; duplicate billing of 81265 with post-transplant 81267/81268 is not expected and may be denied. Claims must include the appropriate CPT and 1 UOS, the DEX Z-Code® identifier in the specified claim fields (SV101-7/SV202-7/NTE/Loop 2400/Box 19/Block 80/UB04), and exceptions to lifetime limits require appeal-based approval.
"Chimerism analysis to identify appropriate donors and to monitor engraftment success or disease recurrence is a covered Medicare service."