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

Molecular syndromic infectious disease panels are covered when billed with the appropriate CPT®/PLA and supporting ICD-10-CM diagnosis documented in the medical record; FDA-cleared/approved tests performed per intended use do not require a DEX Z-code if accompanied by an appropriate ICD-10. Panels are a single unit of service (UOS=1), cannot be unbundled, and have special ordering/documentation requirements for expanded (>5 pathogen) RP/PNP/GI panels (POS limitations or specialist ordering by immune status); CPT 87999 and non-proprietary tests require a DEX Z-code and MolDX Technical Assessment. Repeat testing, multiple related panel submissions on the same date, home-use panels, and missing ICD-10 documentation are restricted or denied per the policy.

"Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT® or PLA code and an accompanying ICD-10-CM diagnosis that documents medical necessity in t..."