Billing and Coding: MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis

This billing/coding guideline requires that only one MolDX molecular biomarker test for rheumatoid arthritis be performed per patient. Claims must include the appropriate CPT code with one unit of service, the corresponding DEX Z-Code placed in the specified claim field for Part A or Part B (Loop 2400/SV101-7 or Item 19 for Part B; SV202-7 or Block 80 for Part A), and an appropriate ICD-10-CM diagnosis code. Do not add additional characters or information on the SV101-7 line when entering the DEX Z-Code.

"Only one molecular biomarker test covered under this policy may be performed for a given patient (maximum one test per patient)."

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