Billing and Coding: MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)

This billing/coding guidance requires that genetic testing for hypercoagulability/thrombophilia (Factor V Leiden, Factor II prothrombin, MTHFR) be billed only when it meets the medical necessity criteria in MolDX LCD L36089. Claims must report the correct CPT code, exactly 1 unit of service, and include the appropriate DEX Z-Code adjacent to the CPT code in the specified electronic or paper claim fields (specific loops/fields and form blocks differ for Part A vs Part B).

"Genetic testing for hypercoagulability/thrombophilia (Factor V Leiden, Factor II prothrombin, and MTHFR) is covered when the service meets the medical necessity and coverage criteria specified in M..."

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