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

Non-NGS testing for the diagnosis of BCR-ABL negative myeloproliferative neoplasms is covered when it meets the LCD DL40022 criteria; single-gene non-NGS testing performed sequentially/reflexively is allowed if LCD criteria are satisfied. Multi-gene panels (including multiplex PCR) must be billed as panels and individual genes that comprise a panel must not be billed separately; each CPT/PLA code is limited to one unit of service once per lifetime per diagnosis. Claims must report the appropriate CPT and ICD-10-CM codes, enter 1 UOS, and include the DEX Z-Code in the specified claim fields (with exact formatting on SV101-7); NGS tests must comply with MolDX L38176 and billing article A57878 and BCR-ABL testing must follow A55233.

"Non-next-generation sequencing (non-NGS) tests for the diagnosis of BCR-ABL negative myeloproliferative neoplasms are covered when all Local Coverage Determination (LCD DL40022) criteria are met."