Billing and Coding: MolDX: Testing of Multiple Genes

Medicare considers parallel analysis of two or more genes for the same indication on the same date a single gene panel that must be billed as one procedural service, while serial/reflex testing requires individual billing per gene. All billed tests must be reasonable and necessary with documentation in the medical record (per CFR §410.32), tests must be registered in the Diagnostics Exchange with correct z-code/CPT, and multiple distinct services on the same date may only be billed with modifier 59 as an attestation and are subject to review.

"When a laboratory assays two or more genes in parallel for the same clinical indication on the same date of service (results of one do not affect completion of others), the tests constitute a singl..."

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