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 MolDX gene expression profile testing to aid decision-making in castration-resistant and metastatic prostate cancer. Submit only one test per patient with 1 unit of service, include the appropriate DEX Z-Code adjacent to the CPT code in the specified Part A/Part B claim fields, and report ICD-10-CM coding with the malignant neoplasm coded first and an additional code for hormone sensitivity as applicable.

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

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