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

This billing/coding policy requires that lab-developed tests for inherited cancer syndromes in patients with cancer be billed in accordance with MolDX LCD L38972 and accompanying MolDX billing guidance. Claims must report the correct CPT code with 1 unit of service, the appropriate ICD-10-CM diagnosis, and the DEX Z-Code® adjacent to the CPT in specified Part A/Part B fields; do not use Tier 1/2 individual biomarker CPTs when testing is performed as part of an NGS or multiplex panel.

"Coverage applies for lab-developed tests (LDTs) for inherited cancer syndromes in patients with cancer when billed in accordance with MolDX LCD L38972."

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