Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers

Coverage is provided for specified MRD tests (notably ClonoSeq) for hematologic malignancies including ALL, MM, CLL, DLBCL, and mantle cell lymphoma, with ClonoSeq also allowed as a single timepoint test for patients with a personal history of cancer. Billing requires test registration with DEX and submission of the DEX Z-Code with the CPT code (or 81479 if no specific CPT), 1 UOS per billed service, and appropriate ICD-10 coding; NGS MRD testing is generally limited to once per cancer diagnosis unless there is documented change in genetic content and testing is not permitted more than once monthly. MolDX technical assessment forms (if available) and clear medical-record documentation of medical necessity are required for coverage determinations.

"ClonoSeq (NGS-based MRD test) is covered for patients with acute lymphoblastic leukemia (ALL)."

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