Billing and Coding: MolDX: Genetic Testing for Lynch Syndrome - R5

This coverage article has been revised and published for notice under contract numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date: December 10, 2020
Summary of Article Changes:

Article Text: Added the subheading Documentation Requirements and Medical Documentation of Suspected LS with the related verbiage “When MSI/IHC testing cannot be performed or is contradictory, claims for MMR germ-line testing exemptions will require the addition of the KX modifier with the billing CPT® code. The KX modifier specifies that the “Requirements specified in the medical policy have been met. Documentation on file”. Documentation must be provided upon request.”
ICD-10 Codes that Support Medical Necessity Group 1: Paragraph: Added the verbiage “and Group 3” to the second paragraph. Typographical errors were corrected throughout the article.

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

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


            Last Updated Wed, 25 Nov 2020 18:08:33 +0000