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

MolDX gene expression profile testing for decision-making in castration-resistant and metastatic prostate cancer is billed using CPT 81542 and is limited to one test (one unit of service) per patient. Claims must include the appropriate DEX Z-Code adjacent to CPT 81542 on specified Part A and B claim fields and list the malignant prostate neoplasm ICD-10-CM first, followed by an additional code for hormone sensitivity status as applicable.

"Gene expression profile testing (bill using CPT 81542) is covered for decision-making in castration-resistant prostate cancer and metastatic prostate cancer per LCD L39688."

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