Billing and Coding: MolDX: Pharmacogenomics Testing

Pharmacogenomic testing is covered when ordered to guide drug selection or dosing for specific drugs under consideration by the ordering physician, subject to documentation of the drugs and clinical decision-making. Claims must include the appropriate CPT/PLA (or 81479 if no specific CPT), 1 unit of service, ICD-10 code, and the DEX Z-Code in the required claim field(s); only one test may be billed per date of service and MolDX Technical Assessment forms must be completed when available. CYP2C9 and VKORC1 testing for warfarin must follow NCD 90.1 requirements.

"Pharmacogenomics (PGx) testing is covered when ordered to guide drug selection or dosing for specific drug(s) that are under consideration or in use by the ordering physician and when results will ..."

Sign up to see full coverage criteria, indications, and limitations.