Billing and Coding: MolDX: Pharmacogenomics Testing

MolDX pharmacogenomics testing is covered when ordered to guide selection or dosing of drug(s) supported by CPIC or FDA gene–drug guidance (see policy Tables 1–2), with CYP2C9/VKORC1 warfarin testing specifically subject to NCD 90.1. Billing requires submission of the appropriate CPT/PLA code and 1 unit of service, inclusion of the DEX Z-Code in the specified claim fields, listing of the drug(s) under consideration, and retention of drug records and documentation of medical necessity; MolDX TA forms are required when available. Only one PGx test may be performed per date of service and use of NOC code 81479 is allowed when no specific CPT exists.

"Pharmacogenomic (PGx) testing is covered when ordered to guide selection or dosing of a drug or drugs being used or considered for the beneficiary where the gene–drug association is supported by CP..."

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