Billing and Coding: ProMark® Risk Score

This billing and coding policy requires ProMark® Risk Score assays to be reported with CPT code 81479 and ICD-10-CM code C61 (prostate cancer), with 1 unit of service per assay. The appropriate DEX Z-Code identifier must be entered adjacent to the CPT code in the specified claim fields depending on Part B (Loop 2400/SV101-7 or Box 19) or Part A (SV202-7 or Block 80) and claim form (837P, paper, 837I, UB04).

"Billing guidance applies when reporting a ProMark® assay service for patients with prostate cancer (use ICD-10-CM code C61)."

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