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

This policy provides billing and coding instructions for lab-developed tests for inherited cancer syndromes referenced to LCD L39040, requiring submission of the appropriate CPT code, 1 unit of service, an adjacent DEX Z-Code in specified claim fields, and an appropriate ICD-10-CM diagnosis code. It prohibits using Tier 1 or Tier 2 individual biomarker CPT codes when the testing is performed as part of NGS or other multiplexing technology panels and directs providers to policy A57880 for multi-gene testing guidance.

"Lab-developed tests for inherited cancer syndromes in patients with cancer as described in Local Coverage Determination (LCD) L39040 are the services addressed by this billing/coding guidance."

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