About this policy
Effective November 19, 2012, Cancer TYPE ID, an RT-PCR 92-gene assay, has been assigned a DEX Z-code ® identifier. To bill for Cancer TYPE ID, please provide the following claim information: Enter “1” in the Days/Unit field Enter DEX Z-Code® identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: Loop 2400 or SV101-7 for the 5010A1 837P Item 19 for paper claim Enter DEX Z-Code® identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: Line SV202-7 for 837I electronic claim Block 80 for the UB04 claim form Select the appropriate ICD-10-CM code. Note: MolDX expects this test to ONLY be ordered by the treating physician.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 81540 | HCPCS | Covered |
| C02.1 | ICD10CM | Covered |
| C08.9 | ICD10CM | Covered |
| C09.9 | ICD10CM | Covered |
| C11.8 | ICD10CM | Covered |
| C15.3 | ICD10CM | Covered |
| C15.4 | ICD10CM | Covered |
| C15.5 | ICD10CM | Covered |
| C15.9 | ICD10CM | Covered |
| C16.0 | ICD10CM | Covered |
| C16.2 | ICD10CM | Covered |
| C16.8 | ICD10CM | Covered |
| C16.9 | ICD10CM | Covered |
| C17.9 | ICD10CM |