Billing and Coding: Molecular Pathology Procedures

This billing and coding guidance requires using CPT molecular pathology codes to report nucleic acid analyses for germline/somatic variants and HLA testing, assigning unlisted CPT 81479 only when no Tier 1/2 code applies, and using HCPCS G0452 with modifier 26 for physician interpretations. Documentation must be maintained to support ICD-10 and CPT/HCPCS coding, demonstrate medical necessity and clinical impact, include signed informed consent and physician requisition, and an ABN must be obtained for tests believed noncovered; refer to LCD L34519 for detailed reasonable and necessary criteria.

"Report molecular pathology CPT codes for nucleic acid analyses to detect germline or somatic gene variants or to test for histocompatibility antigens (e."

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