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 code 81542 and is limited to a single test per patient. Claims must include the appropriate DEX Z-Code adjacent to the CPT code in specified Part A and Part B claim fields, report one unit of service, and sequence ICD-10-CM codes with the malignant neoplasm listed first and an additional code for hormone sensitivity as applicable.

"Gene expression profile testing for decision-making is covered for patients with castration-resistant prostate cancer (CRPC) and/or metastatic prostate cancer."

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