Billing and Coding: MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms

Non-NGS single-gene testing for the diagnosis of BCR-ABL–negative myeloproliferative neoplasms is covered when performed sequentially/reflexively and when all LCD DL39919 criteria are met; an NGS panel may be used in select circumstances per the LCD. Multi-gene panels (NGS or other methods) must be billed as panels and individual genes that are part of a panel must not be billed separately; each listed CPT/PLA code is limited to one unit once per lifetime per diagnosis. Claims must include the appropriate CPT and ICD-10-CM codes, report 1 unit of service, and place the correct DEX Z-Code adjacent to the CPT in the specified Part A/Part B claim fields per the article.

"Non-NGS single-gene testing for diagnosis of BCR-ABL–negative myeloproliferative neoplasms is covered when performed in a sequential and reflexive manner and when all clinical and coverage criteria..."