Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy

This policy provides billing and coding instructions for Prometheus IBD sgi Diagnostic claims: report the applicable CPT code and one unit of service, and include a DEX Z-Code identifier adjacent to the CPT when provided. ABNs are not required for statutorily excluded services (indicate these with modifier GY); if an ABN is voluntarily issued append modifier GX. Specific claim fields for DEX Z-Code placement are defined for Part A (837I/UB04) and Part B (837P/paper).

"Statutorily excluded services are non-covered and must be indicated with the GY modifier on the claim."

Sign up to see full coverage criteria, indications, and limitations.