Billing and Coding: MolDX: Genetic Testing for Hereditary Thrombophilia

This billing guidance requires use of CPT 81240, 81241, or 81479 when billing genetic testing for hereditary thrombophilia (per LCD DL40274) and mandates entering one unit of service. Claims must include the appropriate DEX Z-Code identifier adjacent to the CPT code in the specified fields (Part B: Loop 2400 or SV101-7 for 837P, Box 19 for paper; Part A: Line SV202-7 for 837I, Block 80 for UB04) and must list the applicable ICD-10-CM diagnosis code(s); do not add extra characters when entering the DEX Z-Code on SV101-7.

"Bill molecular/genetic testing for hereditary thrombophilia using CPT code 81240, 81241, or 81479 per LCD DL40274."

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