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

Molecular syndromic infectious disease panels are billed as single-unit tests (UOS=1) using the appropriate proprietary CPT®/PLA code plus supporting ICD-10-CM diagnosis codes documenting medical necessity; FDA-cleared/approved tests performed per intended use may be billed without a DEX Z-Code®. If no specific CPT exists or when multiple tests/special circumstances apply, a DEX Z-Code® and MolDX Technical Assessment are required (CPT® 87999 used when no specific code exists). Expanded (>5 pathogen) RP/PNP/GI panels have additional place-of-service or ordering-specialist requirements, panels intended for home use are not covered, unbundling of panel components is prohibited, and repeat testing is restricted (one additional test allowed 1–14 days only if LCD criteria are met).

"Bill molecular syndromic infectious disease panels with the appropriate proprietary CPT® or PLA code and an accompanying ICD-10-CM diagnosis that supports medical necessity."