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

Coverage for genetic testing for hypercoagulability/thrombophilia (Factor V Leiden, Factor II prothrombin, MTHFR) is governed by MolDX LCD L35984 and is allowed only when that LCD's clinical criteria are met. Claims must include the appropriate CPT code, be billed with 1 unit of service, and have the appropriate DEX Z-Code identifier entered adjacent to the CPT code in the specified Part A or Part B claim fields (Loop 2400/SV101-7 or Box 19 for Part B; SV202-7 or Block 80/UB04 for Part A).

"Genetic testing for hypercoagulability/thrombophilia (Factor V Leiden, Factor II prothrombin, and MTHFR) is covered when it meets the clinical coverage criteria specified in MolDX LCD L35984."

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