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

This billing/coding guidance covers MolDX gene expression profile testing (CPT 81542) for decision‑making in castration‑resistant and metastatic prostate cancer. Claims must use CPT 81542 with 1 unit of service, only one test billed per patient, include the appropriate DEX Z‑Code adjacent to the CPT code in specified Part A/B claim fields, and list the malignant neoplasm ICD‑10‑CM code first with an additional code to indicate hormone sensitivity if applicable.

"Gene expression profile testing (CPT 81542) is intended for decision-making in castration‑resistant prostate cancer."

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