Billing and Coding: MolDX: Minimal Residual Disease Testing for Solid Tumor Cancers

This policy covers specific MRD assays and bundles for solid tumor cancers when clinical validity is established and when testing follows LCD criteria; covered uses include initial MRD testing with prior tumor profiling, certain tumor‑naïve single‑timepoint tests, diagnosis of recurrence/progression for specified cancers, and ICI response monitoring for validated tests. Coverage limits include one UOS per episode and generally one performance per cancer diagnosis for NGS‑based MRD unless there is documented a priori change in tumor genetics; tests for patients without active cancer require a ‘‘personal history of cancer’’ ICD‑10 code and are limited to no more than one test per month. Claims must be registered with DEX, include the assigned DEX Z‑Code and appropriate CPT/ICD coding, and use MolDX forms when required.

"For patients with cancer, MRD testing is covered for an initial test when tumor profiling (prior tumor analysis/CGP) is utilized for the bespoke assay designs and plasma series bundles listed (e."