Billing and Coding: MolDX: Pharmacogenomics Testing

This billing and coding guidance requires that pharmacogenomic testing for specific gene–drug pairs (including CYP2C9/VKORC1 for warfarin per NCD 90.1) be supported by documentation of the drug(s) being considered and submitted on the required claim lines. Claims must include an appropriate CPT/PLA code (or 81479 if no CPT exists), 1 unit of service, the DEX Z-Code®, and an ICD-10-CM code; MolDX test-specific forms are required when available and only one test may be billed per date of service.

"CYP2C9 and VKORC1 pharmacogenomic testing for warfarin dosing is covered when performed in accordance with NCD 90."

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