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LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

A57772

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57772
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)
Article Type
Billing and Coding
Original Effective Date
11/01/2019
Revision Effective Date
01/01/2024
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA) §1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

CMS Manual System, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1 Clinical Laboratory Services.

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 16, §50.5 Jurisdiction of Laboratory Claims, §60.1.1 Independent Laboratory Specimen Drawing, §60.2. Travel Allowance.

CMS Internet-Only Manual Pub 100-04, Medicare Claims Processing Manual, Chapter 23, §10 Reporting ICD Diagnosis and Procedure Codes.

Article Guidance

Article Text

The information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Molecular Diagnostic Tests (MDT) L36807.

To report a Molecular Diagnostic Test service, please submit the following claim information:

  • Select appropriate CPT code
  • Enter 1 unit of service (UOS)
  • Enter the appropriate DEX Z-Code® identifier adjacent to the CPT® code in the comment/narrative field for the following Part B claim field/types:
    • Loop 2400 or SV101-7 for the 5010A1 837P
    • Box 19 for paper claim
  • Enter the appropriate DEX Z-Code® identifier adjacent to the CPT® code in the comment/narrative field for the following Part A claim field/types:
    • Line SV202-7 for 837I electronic claim
    • Block 80 for the UB04 claim form

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.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

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Group 1

(527 Codes)
Group 1 Paragraph

The codes listed below fall within scope of the associated policy but do not automatically imply coverage.

 Group 1 Codes
Code Description
81105 - 81112 Hpa-1 genotyping - Hpa-15 genotyping
81120 Idh1 common variants
81121 Idh2 common variants
81161 - 81168 Dmd dup/delet analysis - Ccnd1/igh translocation alys
81170 - 81179 Abl1 gene - Atxn2 gene detc abnor allele
81180 - 81189 Atxn3 gene detc abnor allele - Cstb gene full gene sequence
81190 - 81194 Cstb gene known famil vrnt - Ntrk translocation analysis
81200 - 81210 Aspa gene - Braf gene
81212 Brca1&2 185&5385&6174 vrnt
81215 - 81219 Brca1 gene known famil vrnt - Calr gene com variants
81220 - 81229 Cftr gene com variants - Cytog alys chrml abnr snpcgh
81230 - 81239 Cyp3a4 gene common variants - Dmpk gene charac alleles
81240 - 81249 F2 gene - G6pd full gene sequence
81250 - 81259 G6pc gene - Hba1/hba2 full gene sequence
81260 - 81269 Ikbkap gene - Hba1/hba2 gene dup/del vrnts
81270 - 81279 Jak2 gene - Jak2 gene trgt sequence alys
81283 - 81289 Ifnl3 gene - Fxn gene known famil variant
81290 - 81299 Mcoln1 gene - Msh6 gene known variants
81300 - 81309 Msh6 gene dup/delete variant - Pik3ca gene trgt seq alys
81310 - 81319 Npm1 gene - Pms2 gene dup/delet variants
81320 - 81329 Plcg2 gene common variants - Smn1 gene dos/deletion alys
81330 - 81339 Smpd1 gene common variants - Mpl gene seq alys exon 10
81340 - 81349 Trb@ gene rearrange amplify - Cytog alys chrml abnr lw-ps
81350 - 81353 Ugt1a1 gene common variants - Tp53 gene known famil vrnt
81355 Vkorc1 gene
81357 U2af1 gene common variants
81360 - 81364 Zrsr2 gene common variants - Hbb full gene sequence
81374 Hla i typing 1 antigen lr
81377 Hla ii type 1 ag equiv lr
81381 Hla i typing 1 allele hr
81383 Hla ii typing 1 allele hr
81400 Mopath procedure level 1
81401 Mopath procedure level 2
81402 Mopath procedure level 3
81403 Mopath procedure level 4
81404 Mopath procedure level 5
81405 Mopath procedure level 6
81406 Mopath procedure level 7
81407 Mopath procedure level 8
81408 Mopath procedure level 9
81410 - 81417 Aortic dysfunction/dilation - Exome re-evaluation
81418 Rx metab gen seq alys pnl 6
81419 Epilepsy gen seq alys panel
81420 Fetal chrmoml aneuploidy
81422 Fetal chrmoml microdeltj
81425 - 81427 Genome sequence analysis - Genome re-evaluation
81430 - 81439 Hearing loss sequence analys - Hrdtry cardmypy gene panel
81440 Mitochondrial gene
81441 Ibmfs seq alys pnl 30 genes
81442 Noonan spectrum disorders
81443 Genetic tstg severe inh cond
81445 So neo gsap 5-50dna/dna&rna
81448 Hrdtry perph neurphy panel
81449 So neo gsap 5-50 rna alys
81450 Hl neo gsap 5-50dna/dna&rna
81451 Hl neo gsap 5-50 rna alys
81455 So/hl 51/>gsap dna/dna&rna
81456 So/hl 51/>gsap rna alys
81457 So neo gsap dna mcrstl ins
81458 So gsap dna cpy nmbr&mcrstl
81459 So neo gsap dna/dna&rna
81460 Whole mitochondrial genome
81462 So gsap cll fr dna/dna&rna
81463 So gsap cl fr cpy nmbr&mcrst
81464 So gsap cll fr mcrstl ins
81465 Whole mitochondrial genome
81470 X-linked intellectual dblt
81471 X-linked intellectual dblt
81479 Unlisted molecular pathology
81493 Cor artery disease mrna
81504 Oncology tissue of origin
81507 Fetal aneuploidy trisom risk
81518 Onc brst mrna 11 genes
81519 Oncology breast mrna
81520 - 81523 Onc breast mrna 58 genes - Onc brst mrna 70 cnt 31 gene
81525 Oncology colon mrna
81528 Oncology colorectal scr
81529 Onc cutan mlnma mrna 31 gene
81540 Oncology tum unknown origin
81541 Onc prostate mrna 46 genes
81542 Onc prostate mrna 22 cnt gen
81546 Onc thyr mrna 10,196 gen alg
81551 Onc prostate 3 genes
81552 Onc uveal mlnma mrna 15 gene
81554 Pulm ds ipf mrna 190 gen alg
81595 Cardiology hrt trnspl mrna
81599 Unlisted maaa
0004M Scoliosis dna alys
0006M Onc hep gene risk classifier
0007M Onc gastro 51 gene nomogram
0011M Onc prst8 ca mrna 12 gen alg
0012M Onc mrna 5 gen rsk urthl ca
0013M Onc mrna 5 gen recr urthl ca
0016M Onc bladder mrna 219 gen alg
0017M Onc dlbcl mrna 20 genes alg
0001U Rbc dna hea 35 ag 11 bld grp
0005U Onco prst8 3 gene ur alg
0016U - 0019U Onc hmtlmf neo rna bcr/abl1 - Onc rna tiss predict alg
0022U Tgsap nsm lung neo dna&rna23
0023U Onc aml dna detcj/nondetcj
0026U Onc thyr dna&mrna 112 genes
0027U Jak2 gene trgt seq alys
0029U Rx metab advrs trgt seq alys
0030U - 0034U Rx metab warf trgt seq alys - Tpmt nudt15 genes
0036U Xome tum & nml spec seq alys
0037U Trgt gen seq dna 324 genes
0040U Bcr/abl1 gene major bp quan
0045U - 0050U Onc brst dux carc is 12 gene - Trgt gen seq dna 194 genes
0055U Card hrt trnspl 96 dna seq
0060U Twn zyg gen seq alys chrms2
0069U Onc clrct microrna mir-31-3p
0070U - 0076U Cyp2d6 gen com&slct rar vrnt - Cyp2d6 3' gene dup/mlt
0078U Pain mgt opi use gnotyp pnl
0079U Cmprtv dna alys mlt snps
0084U Rbc dna gnotyp 10 bld groups
0087U Crd hrt trnspl mrna 1283 gen
0088U Trnsplj kdn algrft rej 1494
0089U Onc mlnma prame & linc00518
0090U Onc cutan mlnma mrna 23 gene
0091U Onc clrct scr whl bld alg
0094U Genome rapid sequence alys
0101U - 0103U Hered colon ca do 15 genes - Hered ova ca pnl 24 genes
0111U Onc colon ca kras&nras alys
0113U Onc prst8 pca3&tmprss2-erg
0114U Gi barretts esoph vim&ccna1
0118U Trnsplj don-drv cll-fr dna
0120U Onc b cll lymphm mrna 58 gen
0129U Hered brst ca rltd do panel
0130U - 0138U Hered colon ca do mrna pnl - Brca1 brca2 mrna seq alys
0153U - 0159U Onc breast mrna 101 genes - Msh2 mrna seq alys
0160U - 0162U Msh6 mrna seq alys - Hered colon ca trgt mrna pnl
0169U Nudt15&tpmt gene com vrnt
0170U - 0173U Neuro asd rna next gen seq - Psyc gen alys panel 14 genes
0175U Psyc gen alys panel 15 genes
0177U Onc brst ca dna pik3ca 11
0179U Onc nonsm cll lng ca alys 23
0180U - 0189U Abo gnotyp abo 7 exons - Gypa gnotyp ntrns 1 5 exon 2
0190U - 0199U Gypb gnotyp ntrns 1 5 seux 3 - Sc gnotyp ermap exons 4 12
0200U Xk gnotyp xk exons 1-3
0201U Yt gnotyp ache exon 2
0203U Ai ibd mrna xprsn prfl 17
0204U Onc thyr mrna xprsn alys 593
0205U Oph amd alys 3 gene variants
0209U Cytog const alys interrog
0211U - 0218U Onc pan-tum dna&rna gnrj seq - Neuro musc dys dmd seq alys
0221U Abo gnotyp next gnrj seq abo
0222U Rhd&rhce gntyp next gnrj seq
0229U Bcat1&ikzf1 prmtr mthyln aly
0230U - 0239U Ar full sequence analysis - Trgt gen seq alys pnl 311+
0242U Trgt gen seq alys pnl 55-74
0244U Onc solid orgn dna 257 genes
0245U Onc thyr mut alys 10 gen&37
0246U Rbc dna gnotyp 16 bld groups
0250U Onc sld org neo dna 505 gene
0253U Rprdtve med rna gen prfl 238
0254U Reprdtve med alys 24 chrmsm
0258U Ai psor mrna 50-100 gen alg
0260U Rare ds id opt genome mapg
0262U Onc sld tum rt-pcr 7 gen
0264U Rare ds id opt genome mapg
0265U Rar do whl gn&mtcdrl dna als
0266U Unxpl cnst hrtbl do gn xprsn
0267U Rare do id opt gen mapg&seq
0268U Hem ahus gen seq alys 15 gen
0269U Hem aut dm cgen trmbctpna 22
0270U Hem cgen coagj do 20 genes
0271U Hem cgen neutropenia 24 gen
0272U Hem genetic bld do 60 genes
0273U Hem gen hyprfibrnlysis 8 gen
0274U Hem gen pltlt do 62 genes
0276U Hem inh thrombocytopenia 42
0277U Hem gen pltlt funcj do 40
0278U Hem gen thrombosis 14 genes
0282U Rbc dna gntyp 12 bld grp gen
0285U Onc rsps radj cll fr dna tox
0286U Cep72 nudt15&tpmt gene alys
0287U Onc thyr dna&mrna 112 genes
0288U Onc lung mrna quan pcr 11&3
0289U Neuro alzheimer mrna 24 gen
0290U Pain mgmt mrna gen xprsn 36
0291U Psyc mood do mrna 144 genes
0292U Psyc strs do mrna 72 genes
0293U Psyc suicidal idea mrna 54
0294U Lngvty&mrtlty rsk mrna 18gen
0296U Onc orl&/orop ca 20 mlc feat
0297U Onc pan tum whl gen seq dna
0298U Onc pan tum whl trns seq rna
0299U Onc pan tum whl gen opt mapg
0300U Onc pan tum whl gen seq&opt
0306U Onc mrd nxt-gnrj alys 1st
0307U Onc mrd nxt-gnrj alys sbsq
0313U Onc pncrs dna&mrna seq 74
0314U Onc cutan mlnma mrna 35 gene
0315U Onc cutan sq cll ca mrna 40
0318U Ped whl gen mthyltn alys 50+
0319U Neph rna pretrnspl perph bld
0320U Neph rna psttrnspl perph bld
0323U Iadna cns pthgn next gen seq
0326U Trgt gen seq alys pnl 83+
0327U Ftl aneuploidy trsmy dna seq
0329U Onc neo xome&trns seq alys
0330U Iadna vag pthgn panel 27 org
0331U Onc hl neo opt gen mapping
0332U Onc pan tum gen prflg 8 dna
0333U Onc lvr surveilanc hcc cfdna
0334U Onc sld orgn tgsa dna 84/+
0335U Rare ds whl gen seq feta
0336U Rare ds whl gen seq bld/slv
0339U Onc prst8 mrna hoxc6 & dlx1
0340U Onc pan ca alys mrd plasma
0341U Ftl aneup dna seq cmpr alys
0343U Onc prst8 xom aly 442 sncrna
0345U Psyc genom alys pnl 15 gen
0347U Rx metab/pcx dna 16 gen alys
0348U Rx metab/pcx dna 25 gen alys
0349U Rx metab/pcx dna 27gen rx ia
0350U Rx metab/pcx dna 27 gen alys
0355U Apol1 risk variants
0356U Onc orop/anal 17 dna ddpcr
0362U Onc pap thyr ca rna 82&10
0363U Onc urthl mrna 5 gen alg
0364U Onc hl neo gen seq alys alg
0368U Onc clrct ca mut&mthyltn mrk
0369U Iadna gi pthgn 31 org&21 arg
0370U Iadna surg wnd pthgn 34&21
0371U Iadna gu pthgn semiq dna16&1
0372U Nfct ds gu pthgn arg detcj
0373U Iadna rsp tr nfct 17 8 13&16
0374U Iadna gu pthgn 21 org&21arg
0378U Rfc1 repeat xpnsj vrnt alys
0379U Tgsap sl or neo dna523&rna55
0380U Rx metb advrs trgt sq aly 20
0388U Onc nonsm cll lng ca 37 gen
0389U Ped fbrl kd ifi27&mcemp1 rna
0391U Onc sld tum dna&rna 437 gen
0392U Rx metab gen-rx ia 16 genes
0395U Onc lng multiomics plsm alg
0396U Ob preimpltj tst 300000 dna
0398U Gi baret esph dna mthyln aly
0400U Ob xpnd car scr 145 genes
0401U Crd c hrt ds 9 gen 12 vrnts
0403U Onc prst8 mrna 18 gen dre ur
0405U Onc pncrtc 59 mthltn blk mrk
0409U Onc sld tum dna 80 & rna 36
0410U Onc pncrtc dna whl gn seq 5-
0411U Psyc genom alys pnl 15 gen
0413U Onc hl neo opt gen mapg dna
0416U Iadna gu pthgn 20bct&fng org
0417U Rare ds alys 335 nuc genes
0419U Nrpsyc gen seq vrnt aly 13
0420U Onc urthl mrna xprsn 6 snp
0421U Onc clrct scr sgl amp 8 rna
0422U Onc pan solid tum alys dna
0423U Psyc genomic alys pnl 26 gen
0424U Onc prst8 xom alys 53 sncrna
0425U Genom rpd seq alys ea cmprtr
0426U Genome ultra-rapid seq alys
0428U Onc brst ctdna alys 56/> gen
0433U Onc prst8 5 dna reg mrk pcr
0434U Rx metab advrs vrnt alys 25
0437U Psyc anxiety do mrna 15 bmrk
0438U Rx metab advrs vrnt alys 33

Group 2

(24 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.

 Group 2 Codes
Code Description
81513 Nfct ds bv rna vag flu alg
81514 Nfct ds bv&vaginitis dna alg
87154 Cul typ id bld pthgn 6+ trgt
87483 Cns dna amp probe type 12-25
87505 Nfct agent detection gi
87506 Iadna-dna/rna probe tq 6-11
87507 Iadna-dna/rna probe tq 12-25
87631 Resp virus 3-5 targets
87632 Resp virus 6-11 targets
87633 Resp virus 12-25 targets
87636 Sarscov2 & inf a&b amp prb
87637 Sarscov2&inf a&b&rsv amp prb
87800 Detect agnt mult dna direc
87801 Detect agnt mult dna ampli
87999 Unlisted microbiology px
0115U Respir iadna 18 viral&2 bact
0202U Nfct ds 22 trgt sars-cov-2
0223U Nfct ds 22 trgt sars-cov-2
0225U Nfct ds dna&rna 21 sarscov2
0240U Nfct ds vir resp rna 3 trgt
0241U Nfct ds vir resp rna 4 trgt
0352U Nfct ds bv&vaginitis amp prb
0353U Iadna chlmyd&gonorr amp prb
0402U Nfct agt sti mult amp prb tq
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CPT/HCPCS Modifiers

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 Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

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(1 Code)
Group 1 Paragraph

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 Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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 Group 1 Codes

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ICD-10-PCS Codes

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 Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
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Other Coding Information

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 Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2024 R18

Posted 02/01/2024: 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 CPT/HCPCS Codes Group 1: Codes deleted 0228U. This revision 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.
10/01/2023 R17

Posted 10/26/2023: Under CPT/HCPCS Codes Group 1: Codes the description was revised for 0258U, 0269U, 0271U, 0272U, 0274U, 0277U, 0278U, and 0362U. Added 0403U, 0405U, 0409U, 0410U, 0411U, 0413U, 0416U, 0417U, and 0419U. Deleted 0386U and 0397U. Under CPT/HCPCS Codes Group 2: Codes added 0402U. This revision is due to the 2023 Q4 CPT/HCPCS Code Update and is effective on 10/1/2023.

Under Article Text revised the 3rd and 6th bullets to remove “DEX Z-Code™” and replaced with “DEX Z-Code®”. This revision is effective on 10/1/2023.
07/01/2023 R16

Posted 07/27/2023: Under CMS National Coverage Policy updated section heading. This revision is effective on 7/1/2023.

Under CPT/HCPCS Codes Group 1: Codes added 0388U, 0389U, 0391U, 0392U, 0395U, 0396U, 0397U, 0398U, 0400U, and 0401U. This revision is due to the 2023 Q3 CPT/HCPCS Code Update and is effective on 7/1/2023.
04/01/2023 R15

Posted 04/27/2023: Under CPT/HCPCS Codes Group 1: Codes added 0364U, 0368U, 0369U, 0370U, 0371U, 0372U, 0373U, 0374U, 0378U, 0379U, 0380U, and 0386U. The description was revised for 0022U. This revision is due to the 2023 Q2 CPT/HCPCS Code Update and is effective on April 1, 2023.
01/01/2023 R14

Posted 01/26/2023: Under CPT/HCPCS Codes Group 1: Codes, added 81418, 81441, 81449, 81451, 81456, 0355U, 0356U, 0362U, and 0363U. The description was revised for 81330, 81445, 81450, 81455, 0017M, and 0069U. Under CPT/HCPCS Codes Group 2: Codes, the description was revised for 87999. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is effective on January 1, 2023.
10/01/2022 R13

Posted 10/27/2022: Under CPT/HCPCS Codes Group 1: Codes added 0318U. This revision is due to the Q2 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 04/01/2022.

Under CPT/HCPCS Codes Group 1: Codes added 0327U. This revision is due to the Q3 2022 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 07/01/2022.

Under CPT/HCPCS Codes Group 1: Codes added 0332U, 0333U, 0334U, 0335U, 0336U, 0339U, 0340U, 0341U, 0343U, 0345U, 0347U, 0348U, 0349U, 0350U, deleted 0012U, 0013U, 0014U, 0056U, and the description was revised for 0229U, 0262U, 0276U, 0296U, 0319U. Under CPT/HCPCS Codes Group 2: Codes added 0352U, 0353U. 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.

Under CPT/HCPCS Codes Group 2: Paragraph revised the first and second sentence. Under CPT/HCPCS Codes Group 2: Codes added 81513, 81514, 87154, 87483, 87505, 87506, 87507, 87631, 87632, 87633, 87636, 87637, 0115U, 0202U, 0223U, 0225U, 0240U, 0241U. This revision is retroactive effective for dates of service on or after 04/17/2022.
07/01/2022 R12

Posted 09/01/2022 Under CPT/HCPCS Codes Group 1: Codes the description was revised for 0016M, 0229U, and 0306U. The following codes were added 0323U, 0326U, 0329U, 0330U, and 0331U. This revision is due to the Q3 2022 CPT/HCPCS Code Update and is effective on 07/01/2022. Review completed 07/25/2022.
05/17/2022 R11

Posted 05/26/2022-Under CPT/HCPCS Codes Group1: Codes added 0306U, 0307U, 0313U, 0314U, 0315U, 0319U, 0320U and revised the description for 0022U. This revision is due to the Q2 CPT/HCPCS Code Update and is effective for dates of service on or after 04/01/2022.

Under CPT/HCPCS Codes Group 2: Paragraph added the verbiage, “However, for molecular microbiology tests using codes 87800 and 87801, a Z-code is only required for non-FDA-approved/cleared services/tests.”

Under CPT/HCPCS Codes Group2: added codes 87800 and 87801. This revision is effective on 05/17/2022. Review completed 05/05/2022.
04/17/2022 R10

Posted 04/28/2022-Moved CPT 81599 from CPT/HCPCS Codes Group 1 to CPT/HCPCS Codes Group 2. Added CPT 87999 to Group 2 codes and added “The following CPT codes require a Z-code if the testing is molecular (DNA/RNA) based” to Group 2 Paragraph.
01/01/2022 R9

01/27/2022-Under CPT/HCPCS Codes Group 1: Paragraph added the verbiage “The codes listed below fall within scope of the associated policy but do not automatically imply coverage. Under CPT/HCPCS Codes Group 1: Codes added 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0296U, 0297U, 0298U, 0299U, 0300U, 81349, and 81523. Deleted 0208U. This revision is effective 01/01/2022.
01/01/2022 R8

12/30/2021-CPT/HCPCs code update: desc change for 0016M, 0017M, 0090U, 0154U, 0155U, 0177U, 0180U, 0193U, 0200U, 0205U, 0216U, 0221U, 0244U, 0258U, 0262U, 0265U, 0266U, 0276U, 81194, 81228, 81229.
10/01/2021 R7

11/25/2021- Under CPT/HCPCS Codes Group 1: Codes added 0258U, 0260U, 0262U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, 0282U and deleted 0168U. This revision is due to the Q4 2021 CPT®/HCPCS Code Update and is effective for dates of service on or after 10/1/2021.Review completed 10/20/2021.
07/01/2021 R6

08/26/2021-Under CPT/HCPCS Group 1: Codes added 0016M. This revision is due to coding that is applicable to the MolDX program and is retroactive effective for dates of service on or after 01/01/2021.

Under CPT/HCPCS Codes Group 1: Codes added 0250U. This revision is due to the Q3 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 07/01/2021.
04/01/2021 R5

05/27/2021- Under CPT/HCPCS Group 1: Codes added 0017M and deleted 0105U. This revision is due to coding that is applicable to the MolDX program and is retroactive effective for dates of service on or after 1/1/2021.

Under CPT/HCPCS Group 1: Codes added 0242U, 0244U, 0245U, and 0246U. 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.
01/01/2021 R4

02/25/2021-Under CPT/HCPCS Codes Group 1: Codes added 81374, 81377, 81381, 81383, 0069U, 0133U, 0168U, 0169U, 0170U, 0171U, 0172U, 0173U, 0175U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U 0201U, 0203U, 0204U, 0205U, 0208U, 0209U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0221U, and 0222U and deleted 81490, 81500, 81503, 81506, 81508, 81509, 81510, 81511, 81512, 81535, 81536, 81538, 81539, 84999, 85999, 86152, 86153, 86849, 87999, 0003U, 0009U, 0021U, 0024U, 0039U, 0053U, 0054U, 0058U, 0059U, 0062U, 0067U, 0068U, 0080U, 0083U, 0092U, 0107U, and 0108U. Under CPT/HCPCS Codes Group 2: Codes moved 81401, 81403, 81406, 81407, 81412 to CPT/HCPCS Codes Group 1: Codes.
This revision is due to coding that is applicable to the MolDX program and is retroactive effective for dates of service on or after 1/1/2021.

Under CPT/HCPCS Codes Group 1: Codes added 81168, 81191, 81192, 81193, 81194, 81278, 81279, 81338, 81339, 81347, 81348, 81351, 81352, 81353, 81357, 81360, 81419, 81529, 81546, 81554, 0228U, 0229U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0239U, deleted 81545.
This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.
10/01/2020 R3

11/26/2020- Under CPT/HCPCS codes Group 1: 0154U code description was revised due to Q4 CPT/HCPCs code updates.
04/01/2020 R2

05/28/2020-Under CPT/HCPCS Codes Group 1: Codes- description change for CPT codes 0154U & 0155U. Formatting, & punctuation corrected under CMS National Coverage Policy section. This revision is due to the Q2 2020 CPT/HCPCS code update. Review completed 04/28/2020.
01/01/2020 R1

12/26/2019- Under CPT/HCPCS Codes Group 1: Codes added CPT® codes 87999, 0045U-0050U, 0053U-0060U, 0062U, 0067U, 0068U, 0070U-0076U, 0078U-0080U, 0083U, 0105U, 0107U, 0108U, 0111U, 0113U, 0114U, 0118U, 0120U, 0129U-0132U, and 0134U-0138U. CPT® codes 81370-81383, 81596, 88120, 88121, 0002M, 0003M, 0002U, 0006U-0008U, 0010U, 0011U, 0025U, 0035U, 0038U, 0041U-0044U, 0086U, 0093U, 0095U-0100U were deleted. These additions and deletions are due to coding that is applicable to the MolDX program.

Added 0084U-0104U due to 3rd quarter 2019 CPT/HCPCS code updates-effective 07/01/2019. 0104U was deleted due to 4th quarter code update & 0008U, 81404 and 81407 descriptions changed –effective 10/01/20119. Moved CPT codes 81401, 81403, 81406, 81407 and 81412 from Group 1 to Group 2 CPT/HCPCS code section and added “CPT codes that are also referenced in other articles” to the Group 2 paragraph.

Effective 01/01/2020: Annual CPT®/HCPCS Code Update: Under CPT/HCPCS Codes Group 1: Codes added CPT® codes 81277, 81307, 81308, 81309, 81522, 81542, 81552, and code range 0153U-0162U. CPT® codes 0009M and 0085U were deleted. The code descriptions were revised for CPT® codes 81350, 0101U, 0102U, and 0103U.

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