Billing and Coding: 4Kscore Test Algorithm

Coverage for the 4Kscore test is governed by Local Coverage Determination L37798 and must meet that LCD's reasonable and necessary requirements. Strong documentation is required: complete, legible medical records supporting ICD-10 and CPT/HCPCS coding, provider signature, and documented shared decision-making (with patient/provider name, date, and signature) provided to the performing laboratory.

"Coverage and medical necessity for the 4Kscore test follow Local Coverage Determination L37798; refer to LCD L37798 for specific reasonable and necessary indications."

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