Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

This billing/coding guideline applies to lab-developed tests for inherited cancer syndromes in patients with cancer (per LCD L38966) and requires specific claim elements including CPT code, 1 unit of service, DEX Z-Code placement, and an ICD-10-CM diagnosis code. Do not report Tier 1 or Tier 2 individual biomarker CPT codes when testing is performed as part of an NGS or other multiplexing technology panel; refer to policy A57503 for single-gene and panel testing guidance.

"Lab-developed tests for inherited cancer syndromes in patients with cancer (per LCD L38966) are covered when billed with the required claim elements specified in this policy."

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