Billing and Coding: MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer

This billing/coding guideline requires reporting the appropriate CPT code with one unit of service, the appropriate DEX Z-Code adjacent to the CPT code, and an appropriate ICD-10-CM diagnosis code when submitting claims for molecular biomarker tests used to risk-stratify patients at increased risk for prostate cancer under MolDX LCD L39042. Only one molecular biomarker test is allowed per patient per date of service and only one test per clinical indication; specific claim-field requirements apply for Part A (SV202-7, Block 80 UB-04) and Part B (Loop 2400, SV101-7, Box 19) submissions, and no extra characters may be added to the SV101-7 DEX Z-Code field.

"Molecular biomarker testing to risk-stratify patients at increased risk for prostate cancer when allowed by MolDX Local Coverage Determination L39042."

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