Billing and Coding: Genetic Testing for Oncology

Medicare billing for oncology genetic testing requires adherence to LCD L39365, the AMA CPT Codebook, and the NCCI Policy Manual; CPT codes must match the documented disease, genes tested, specimen source, and methodology. Units of service must reflect the CPT/NCCI-defined UOS (e.g., per source specimen for FISH, single UOS for defined genomic panels), and overlapping or duplicate CPT codes that describe the same analyte or exceed performed UOS are not permitted.

"Genetic testing CPT codes are covered when testing is reasonable and necessary per Local Coverage Determination L39365 and the AMA CPT Codebook and Medicare NCCI Policy Manual instructions are foll..."

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