Billing and Coding: MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer

This billing/coding guidance requires reporting the appropriate CPT and ICD-10-CM codes, entering 1 unit of service, and including the DEX Z-Code identifier adjacent to the CPT code in specified claim fields for Part A and Part B claims. Only one molecular biomarker test is allowed per date of service and only one test is allowed per given clinical indication as permitted by LCD L38985; follow the SV101-7 entry rule to avoid adding extra characters to the DEX Z-Code.

"Molecular biomarker testing to risk-stratify patients who are at increased risk for prostate cancer as allowed by LCD L38985."

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