Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (A58726) - R11 - Effective October 01, 2023

This coverage article has been revised and published for notice under contract numbers: 02101 (AK), 02201 (ID), 02301 (OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY).

Effective Date: October 01, 2023

Summary of Article Changes: Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added J15.61 and J15.69. Under ICD-10 Codes that Support Medical Necessity Group 2: Codes added K35.200, K35.201, K35.209, K35.210, K35.211, K35.219, K63.8211, K63.8212, K63.8219, K63.822, and K63.829. Under ICD-10 Codes that Support Medical Necessity Group 4: Codes added A41.54 and B96.83. Under ICD-10 Codes that Support Medical Necessity Group 6: Codes added J44.81 and J44.89. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/2023.

Under Article Text revised the 4th bullet 2nd sentence to add "and a TA. If an existing CPT® code does not identify the service, it requires the use of CPT® code 87999". Deleted the 3rd and 4th sentences. Revised the 7th and 10th bullets to remove "DEX Z-Code™" and replaced with "DEX Z-Code®". This revision is effective on 10/1/2023.

Visit the Molecular Diagnostic Services (MolDX) webpage to access the MolDX Medicare Coverage Article from the "Covered Tests" or the "Excluded Tests" webpage.

To view the complete listing of coverage articles and/or access the Active, Future, or Retired articles available in the CMS MCD, visit the Medicare Coverage Articles webpage.

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