Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT) (A57527) - R16- January 1, 2024

Date Posted: January 11, 2024

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: January 1, 2024

Summary of Article Changes:

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 0356U, 81171, 81172, 81243, 81244, 81445, 81449, 81450, 81451, 81455, and 81456. Added 81457, 81458, 81459, 81462, 81463, 81464, 0420U, 0421U, 0422U, 0423U, 0424U, 0425U, 0426U, 0428U, 0433U, 0434U, 0437U, and 0438U. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is effective 1/1/2024.

Under Article Text added "NOTE: 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". Under CPT/HCPCS Group 1: Codes added 81599, 0253U, and 0254U. Under CPT/HCPCS Group 2: Paragraph revised first sentence to read "For DNA/RNA based testing that use CPT® code 87999 a Z-code is required for claims submission". Under CPT/HCPCS Group 2: Codes deleted 81599. This revision is effective 1/1/2024.

Updated CPT/HCPCS Codes Group 2 Paragraph "For DNA/RNA based testing that use CPT® code 87999 a Z-code is required for claims submission. Any remaining molecular microbiology tests that are non-FDA approved/cleared services/tests also require a Z-code for claims submission." Noridian has modified certain language in the articles to mirror the language used presently by the MolDX team at Palmetto GBA as part of an annual review. Revision history dates and language may not exactly match the MolDX PGBA revision history. However, these revisions do not change coverage or guidance.

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.

Last Updated Jan 11 , 2024