Billing and Coding: MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia

This billing/coding guideline specifies claim submission requirements for MolDX molecular testing for upper GI metaplasia/dysplasia/neoplasia: providers must report the appropriate CPT and ICD-10-CM codes, report exactly 1 unit of service per test line, and include the DEX Z-Code adjacent to the CPT code in the specified claim fields. For Part B use Loop 2400 or SV101-7 (837P) or Item 19 (paper); for Part A use Line SV202-7 (837I) or Block 80 (UB04). Failure to include these elements may result in claim denial.

"Claims that do not include the required CPT/ICD-10 codes, 1 unit of service, and the appropriate DEX Z-Code in the specified claim field may be denied."

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