Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

Molecular syndromic infectious disease panels are covered when billed with appropriate CPT/PLA codes and supporting ICD-10-CM diagnosis codes; FDA-approved tests used consistent with labeling generally do not require a MolDX Z-code, whereas tests lacking a specific CPT/PLA code or when multiple tests/services require billing with CPT 87999 will require a DEX Z-code and Technical Assessment. Panels are single-unit services (UOS=1) that cannot be unbundled; expanded (>5 pathogen) RP/PNP/GI panels have additional place-of-service or ordering-provider requirements and pre-transplant and limited repeat-testing exceptions apply.

"FDA-approved/cleared molecular infectious disease pathogen identification tests performed consistent with their intended use and billed with an appropriate accompanying ICD-10-CM diagnosis code are..."

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