Billing and Coding: Biomarkers Overview

This billing and coding article directs users to follow LCD L35062 for biomarker coverage and reasonable/necessary criteria. CPT 81490 is limited to two services per rolling year per beneficiary; claims must use the most specific ICD-10-CM codes documented, include legible patient identification and provider signature, and must not bill non-covered services as covered (use appropriate modifier when billing non-covered services).

"Coverage determinations for biomarker testing follow Local Coverage Determination L35062 and services are covered when reasonable and necessary per that LCD."

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