Billing and Coding: MolDX: Pharmacogenomics Testing

MolDX covers pharmacogenomics testing when ordered to guide selection or dosing of specific drug(s) under consideration by the ordering physician and when the test is likely to identify actionable alleles/variants; gene–drug pairs listed in the policy tables are examples of covered scenarios. Claims must include the appropriate CPT/PLA (or 81479 if no CPT), one unit of service, the appropriate DEX Z-Code and ICD-10 code, and must list the drug(s) under consideration; only one PGx test is allowed per date of service and CYP2C9/VKORC1 warfarin testing must comply with NCD 90.1.

"Pharmacogenomics (PGx) testing is covered when ordered to guide selection or dosing of specific drug(s) that the ordering physician is considering for the beneficiary and when the test is likely to..."

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