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

This billing and coding guidance supplements LCD L38974 for lab-developed tests for inherited cancer syndromes in patients with cancer and specifies required claim elements (appropriate CPT, one unit of service, DEX Z-Code placement, and ICD-10-CM diagnosis). Do not report Tier 1 or Tier 2 individual biomarker CPT codes when testing is performed as part of NGS or other multiplex panels; refer to policy A58121 for guidance on single-gene and multi-gene panel testing.

"Lab-developed tests for inherited cancer syndromes in patients with cancer are billed per this guidance and the referenced LCD L38974."

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