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

Molecular syndromic infectious disease panels are billable when the appropriate CPT/PLA (or CPT 87999 with Z-Code/TA) and supporting ICD-10-CM codes are submitted and the medical record documents medical necessity; panels are single tests (UOS=1) and cannot be unbundled. Expanded (>5 pathogen) RP/PNP/GI panels have additional place-of-service or specialist-ordering and ICD-10 documentation requirements, and panels intended for home use are not covered; repeat testing is generally not reimbursed except per limited LCD criteria (one additional test permitted 1–14 days when justified).

"Molecular syndromic panels for infectious disease pathogen identification are covered when billed with the appropriate proprietary CPT®/PLA code (or acceptable CPT code) and accompanied by supporti..."

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