Billing and Coding: 4Kscore Test Algorithm

Coverage for the 4Kscore test is determined by meeting the reasonable and necessary requirements in LCD L37792; refer to that LCD for specific clinical indications. Claims must be supported by complete, legible medical records including ICD-10 and CPT/HCPCS support, clinician signature, and documented shared decision-making (SDM) with the patient (SDM must be provided to the performing lab before testing). Do not bill Medicare for non-covered services as covered and, if billing non-covered services, submit the appropriate modifier.

"4Kscore testing is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L37792."

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