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

Billing for molecular biomarker tests to risk-stratify patients at increased risk for prostate cancer must follow MolDX LCD L39005 and the specified claim-entry requirements. Claims must report the appropriate CPT and ICD-10-CM codes, include 1 unit of service, and include the DEX Z-Code in the designated claim fields (with no extra characters on SV101-7); only one such test may be billed per date of service and per clinical indication.

"Molecular biomarker tests to risk-stratify patients at increased risk for prostate cancer are billable when ordered consistent with MolDX LCD L39005."

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