Billing and Coding: MolDX: Prometheus® IBD sgi Diagnostic® Policy

Billing for the Prometheus IBD sgi Diagnostic requires selecting the applicable CPT code and reporting exactly one unit of service. DEX Z‑Codes, when used, must be entered adjacent to the CPT code in specific claim fields depending on Part A vs Part B and electronic vs paper claim type; ABNs are not required for statutorily excluded services, use modifier GX for voluntary ABNs and GY to indicate statutory exclusion.

"If the service is statutorily excluded, indicate it by appending the GY modifier to the claim."

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