Billing and Coding: MolDX: Gene Expression Profile Tests for Decision-Making in Castration Resistant and Metastatic Prostate Cancers

This billing guideline requires use of CPT 81542 for gene expression profile testing to guide decision-making in castration‑resistant or metastatic prostate cancer. Only one test per patient is billable, with one unit of service (UOS=1) required, the appropriate DEX Z‑Code must be included adjacent to the CPT code in specified claim fields for Part A and Part B, and ICD‑10‑CM coding must list the malignant neoplasm first followed by any code(s) indicating hormone sensitivity status.

"Gene expression profile testing (CPT 81542) is used for clinical decision-making in patients with castration-resistant prostate cancer (CRPC) or metastatic prostate cancer."

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