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

This billing and coding guidance specifies claim-level requirements for the Prometheus IBD sgi Diagnostic test: report the applicable CPT code and enter 1 unit of service. ABN is not required for statutorily excluded services (use GY modifier to indicate statutory exclusion and GX for voluntary ABN), and if using a DEX Z‑Code identifier place it adjacent to the CPT code in the specified Part A/Part B claim fields (Loop 2400/SV101-7 or Item 19 for Part B; SV202-7 or Block 80 for Part A).

"Select and report the applicable CPT code for the Prometheus IBD sgi Diagnostic test on the claim."

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