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Billing and Coding: MolDX: Pigmented Lesion Assay
A58053
Effective: December 23, 2021
Updated: December 31, 2025
Policy Summary
This billing/coding guideline requires reporting the appropriate CPT and ICD-10-CM codes and submission of exactly 1 unit of service for the MolDX Pigmented Lesion Assay. The DEX Z‑Code identifier must be entered adjacent to the CPT code in the specified claim fields: for Part B (Loop 2400 or SV101-7 on 837P electronic; Item 19 on paper) and for Part A (SV202-7 on 837I electronic; Block 80 on UB04).
Coverage Criteria Preview
Key requirements from the full policy
"Report the appropriate CPT code for the Pigmented Lesion Assay on the claim."
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