Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

This billing and coding guidance specifies required claim elements for MolDX lab-developed tests for inherited cancer syndromes: report the appropriate CPT code with 1 unit of service, include an ICD-10-CM diagnosis code, and place the DEX Z-Code identifier adjacent to the CPT code in the specified Part A or B claim fields. Do not report Tier 1 or Tier 2 individual biomarker CPT codes when testing is performed as part of an NGS or other multiplexing panel; refer to MolDX Testing of Multiple Genes policy A57910 for panel testing details.

"Do not report Tier 1 or Tier 2 individual biomarker CPT codes for a single gene or any combination of genes when testing is performed as part of an NGS or other multiplexing technology panel."

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