Billing and Coding: MolDX: Testing of Multiple Genes

Genetic testing is covered when tests (panels or individual genes) are reasonable and necessary for the beneficiary's specific medical problem and documented in the medical record per CFR §410.32. Tests assayed in parallel constitute a panel and must be billed as a single HCPCS/CPT code, while serial (reflex) testing should be billed as individual gene services with each test justified; generally no more than two distinct genetic testing services should be billed on the same date without attestation using modifier 59.

"A multi-gene panel is covered when two or more genes are assayed in parallel and the panel is reasonable and necessary for the beneficiary, as documented in the medical record and reflected on the ..."

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