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

Non‑NGS single‑gene and multi‑gene panel testing for diagnosis of BCR‑ABL–negative myeloproliferative neoplasms is permitted when LCD DL39923 criteria are met; multi‑gene tests must be billed as a single panel. Billing requires 1 unit of service per CPT/PLA line, inclusion of the appropriate DEX Z‑Code adjacent to the CPT/PLA code in specified claim fields, and is limited to once per lifetime per diagnosis; separate billing for individual panel genes or duplicate billing with panel and single‑gene tests for the same use is not compliant.

"Non‑NGS single‑gene tests for the diagnosis of BCR‑ABL–negative myeloproliferative neoplasms are covered when performed sequentially or reflexively and when all criteria in the applicable LCD (DL39..."

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