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

This billing/coding guidance specifies that molecular biomarker tests to risk-stratify patients at increased risk for prostate cancer are reimbursable only when they meet the clinical criteria of MolDX LCD L38997. Claims must include the appropriate CPT code with 1 unit of service, the supporting ICD-10-CM diagnosis, and the DEX Z-Code entered adjacent to the CPT in the specified Part A/Part B fields; only one test is allowed per date of service and per clinical indication.

"Molecular biomarker tests to risk-stratify patients at increased risk for prostate cancer are covered when they meet the clinical indications and medical necessity criteria specified in MolDX LCD L..."

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