Billing and Coding: MolDX: Minimal Residual Disease Testing for Solid Tumor Cancers (A58456) - R2 - Effective October 1, 2022

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 1, 2022

Summary of Article Changes:

  • Under Article Text revised table one and under table added verbiage, “Guardant Test - Coverage criteria under the policy have been met for the diagnosis of disease progression, recurrence, or relapse for colon cancer.” This revision is retroactive effective for dates of service on or after 10/1/2022.
  • Under Article Text revised verbiage in first sentence under table to include “bladder cancer”. This revision is effective for dates of service on or after 10/1/2022.
  • Under Article Text, first paragraph under the table removed last sentence and revised fourth sentence under table. Under Article Text under billing instructions added verbiage, “When submitting claims for the specific indicated use of monitoring response to ICI therapy, the ICI drug name must be included on the claim in the applicable detail line 2400 loop.” Under CPT/HCPCS Codes Group1: Paragraph revised verbiage. Under CPT/HCPCS Codes Group 2: Paragraph deleted verbiage. Under CPT/HCPCS Codes Group 2: Codes deleted 81479. Under CPT/HCPCS Codes moved Group 3 Paragraph and code to become Group 2 and revised verbiage. Under ICD-10 Codes that Support Medical Necessity Group 2: Paragraph deleted verbiage. Under ICD-10 Codes that Support Medical Necessity Group 2: Codes deleted all codes. Under ICD-10 Codes that Support Medical Necessity moved Group 3 Paragraph and codes to become Group 2 and revised verbiage. This revision is effective for dates of service on or after 10/01/2022.
  • Under CPT/HCPCS Codes Group1: Codes added 0340U. This revision is due to the Q4 2022 CPT/HCPCS Code Update and is effective for dates of service on or after 10/01/2022.

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

Last Updated Jan 11 , 2023