Billing and Coding: MolDX: Proteomics Testing

Proteomics tests are covered under this policy only when they are multianalyte assays in which proteins are the major analytes, measure analyte interactions, rely on informatics/algorithms to generate results, and demonstrate clinical validity based on analyte interactions. All proteomics tests in MolDX jurisdictions must register with the DEX Registry and obtain a Z‑Code, undergo MolDX technical assessment by Palmetto GBA, be billed with an appropriate CPT/PLA/81599 code, include one unit of service, and report the Z‑Code in the specified claim fields; enforcement of reimbursement changes begins 2025-01-31 (registration/assessment effective 2024-01-31).

"Test is considered a proteomics test if it is a multianalyte assay in which proteins are the major or essential analytes measured."

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