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

MolDX A58468 covers specified MRD tests for solid tumors when medical necessity is documented and, for many tests, when prior tumor profiling is used; tumor‑naïve single‑plasma tests are covered for specified products. For patients with cancer, MRD testing is generally limited to one UOS per cancer diagnosis (repeat testing only with documented a priori change in genetic content per NCD 90.2); for patients without cancer one timepoint = 1 UOS and testing is limited to no more than once per month. Billing requires DEX registration and submission of the assigned DEX Z‑Code (use CPT 81479 when no specific CPT exists), enter 1 UOS, include appropriate ICD‑10 code (and ICI drug name when applicable), and follow MolDX TA form requirements when available.

"Initial MRD testing is covered for patients with cancer when baseline tumor profiling from a prior analysis is utilized, using listed bespoke/plasma-series MRD tests (e."