Billing and Coding: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)

MS testing for monoclonal gammopathy is covered only when performed in accordance with the applicable LCD and when documentation shows the test is expected to influence patient treatment or management. Claims must include a valid ICD-10-CM diagnosis code and, when required, the referring/ordering physician's name and NPI; screening, pre-symptomatic testing, or risk assessments that do not directly affect management are not covered. Laboratories must retain and provide on request supporting documentation including physician requisitions, lab accreditation, test records, and for LDTs, analytical and clinical validity/utility evidence.

"Mass spectrometry (MS) testing is covered when the medical record documents that the testing is expected to influence the treatment or management of the condition for which the test is ordered."

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