Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors (A57901) - R1 - Effective January 01, 2022

This Billing and Coding Article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI), and 01312 (NV).

Effective Date: January 01, 2022

Summary of Article Changes:

Under CPT/HCPCS Codes Group#1: Codes the description was revised for 0244U. This revision is due to the 2022 Annual CPT/HCPCS Code Update and is effective on January 1, 2022. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added: C00.2, C00.5, C00.9, C02.9, C03.9, C04.9, C05.9, C06.9, C09.9, C10.9, C11.9, C13.9, C15.9, C16.9, C17.9, C18.9, C25.9, C31.9, C32.9, C38.3, C41.9, C43.9, C4A.9, C44.99, C45.9, C47.9, C48.2, C49.9, C49.A0, C51.9, C53.9, C54.9, C57.9, C60.9, C63.9, C67.9, C68.9, C70.9, C71.9, and C75.9.The deletion of these codes with Revision 1 was done in error and is retroactive effective for dates of service on or after 06/24/2021.

10/01/2021: Under CPT/HCPCS Codes Group 1: Codes added 0250U. This revision is due to the Q3 2021 CPT/HCPCS Code Update and is effective for dates of service on or after 7/1/2021. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added C56.3. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/2021.

06/24/2021: Under CPT/HCPCS Codes Group 1: Codes added 0244U. This revision is due to the Q2 2021 CPT/HCPCS Code Update and is effective for dates of service on or after 4/1/2021. Under CMS National Coverage Policy removed regulation CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15 §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests and §80.1.1 Certification Changes and §80.2 Clinical Laboratory Services. Added regulation CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15 §80.1.2 A/B MAC (B) Contacts with Independent Clinical Laboratories. Under Article Text added the verbiage, “Relevant Article: Billing and Coding: MolDX: Testing of Multiple Genes A57503” and added verbiage regarding instructions on how to submit claims information. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted C00.2, C00.5, C00.9, C02.9, C03.9, C04.9, C05.9, C06.9, C09.9, C10.9, C11.9, C13.9, C15.9, C16.9, C17.9, C18.9, C25.9, C31.9, C32.9, C38.3, C41.9, C43.9, C4A.9, C44.99, C45.9, C47.9, C48.2, C49.9, C49.A0, C51.9, C53.9, C54.9, C57.9, C60.9, C63.9, C67.9, C68.9, C70.9, C71.9, and C75.9.

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, 30 Mar 2022 19:40:09 +0000