Billing and Coding: Thyroid Nodule Molecular Testing

This billing and coding guidance complements the LCD for thyroid nodule molecular testing and requires that testing meet the LCD's clinical and medical necessity criteria. Claims must include a valid ICD-10-CM diagnosis code, and when applicable must report the referring/ordering physician name and NPI; procedure codes may be subject to NCCI or OPPS packaging edits. The medical record must document medical necessity, including history, physical exam, and pertinent diagnostic test results, and diagnostic test results should be reported on the claim if known.

"Thyroid nodule molecular testing is covered when it meets the clinical indications and medical necessity criteria specified in the attached Local Coverage Determination (LCD)."

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