Billing and Coding: MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Targeted Therapy in Cancer

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for proposed LCD MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Targeted Therapy in Cancer L40226. Relevant Article: Billing and Coding: MolDX: Testing of Multiple Genes A57910. To report a Non-Next Generation Sequencing Targeted Molecular Panel Tests for Targeted Therapy in Cancer service, please submit the following claim information: Select the appropriate CPT ® code Enter 1 unit of service (UOS) Enter the appropriate 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 Box 19 for paper claim Enter the appropriate 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 NOTES: When entering the DEX Z-Code ® on the SV101-7 documentation field for Part B claims please do not add additional characters and/or information on the line. NGS-based testing after a positive non-NGS result for an actionable biomarker is considered duplicative testing when performed for the same cancer indication for the same genetic content and will be denied. IF additional genomic data beyond what is available on the non-NGS panel will inform management and this was NOT known prior to non-NGS panel testing, the physician may submit an appeal for medical review. We expect this situation to be rare. Specific tests that have been evaluated for compliance with coverage criteria set in policy (and are thus covered or not covered) can be found in the DEX ® registry located at www.dexzcodes.com .