Local Coverage Article Billing and Coding

Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®

A54388

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Contractor Information

Article Information

General Information

Article ID
A54388
Article Title
Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/01/2021
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 2022 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 © 2022 American Dental Association. All rights reserved.

Copyright © 2022, 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

N/A

Article Guidance

Article Text

The following coding and billing guidance is to be used with its associated Local coverage determination.

 To bill for Cancer TYPE ID, please provide the following claim information:

  • Enter “1” in the Days/Unit field
  • Enter 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
    • Item 19 for paper claim
  • Enter 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
  • Select the appropriate ICD-10-CM code.


Note: MolDX expects this test to ONLY be ordered by the treating physician.

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
81540 ONCOLOGY (TUMOR OF UNKNOWN ORIGIN), MRNA, GENE EXPRESSION PROFILING BY REAL-TIME RT-PCR OF 92 GENES (87 CONTENT AND 5 HOUSEKEEPING) TO CLASSIFY TUMOR INTO MAIN CANCER TYPE AND SUBTYPE, UTILIZING FORMALIN-FIXED PARAFFIN-EMBEDDED TISSUE, ALGORITHM REPORTED AS A PROBABILITY OF A PREDICTED MAIN CANCER TYPE AND SUBTYPE

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(256 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
C02.1 Malignant neoplasm of border of tongue
C08.9 Malignant neoplasm of major salivary gland, unspecified
C09.9 Malignant neoplasm of tonsil, unspecified
C11.8 Malignant neoplasm of overlapping sites of nasopharynx
C15.3 Malignant neoplasm of upper third of esophagus
C15.4 Malignant neoplasm of middle third of esophagus
C15.5 Malignant neoplasm of lower third of esophagus
C15.9 Malignant neoplasm of esophagus, unspecified
C16.0 Malignant neoplasm of cardia
C16.2 Malignant neoplasm of body of stomach
C16.8 Malignant neoplasm of overlapping sites of stomach
C16.9 Malignant neoplasm of stomach, unspecified
C17.9 Malignant neoplasm of small intestine, unspecified
C18.0 Malignant neoplasm of cecum
C18.2 Malignant neoplasm of ascending colon
C18.4 Malignant neoplasm of transverse colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C18.9 Malignant neoplasm of colon, unspecified
C22.0 Liver cell carcinoma
C22.1 Intrahepatic bile duct carcinoma
C22.7 Other specified carcinomas of liver
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
C22.9 Malignant neoplasm of liver, not specified as primary or secondary
C23 Malignant neoplasm of gallbladder
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C24.9 Malignant neoplasm of biliary tract, unspecified
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C25.9 Malignant neoplasm of pancreas, unspecified
C26.9 Malignant neoplasm of ill-defined sites within the digestive system
C31.9 Malignant neoplasm of accessory sinus, unspecified
C32.0 Malignant neoplasm of glottis
C32.8 Malignant neoplasm of overlapping sites of larynx
C33 Malignant neoplasm of trachea
C34.00 Malignant neoplasm of unspecified main bronchus
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.10 Malignant neoplasm of upper lobe, unspecified bronchus or lung
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.30 Malignant neoplasm of lower lobe, unspecified bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.80 Malignant neoplasm of overlapping sites of unspecified bronchus and lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung
C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung
C34.91 Malignant neoplasm of unspecified part of right bronchus or lung
C34.92 Malignant neoplasm of unspecified part of left bronchus or lung
C37 Malignant neoplasm of thymus
C38.3 Malignant neoplasm of mediastinum, part unspecified
C38.4 Malignant neoplasm of pleura
C40.01 Malignant neoplasm of scapula and long bones of right upper limb
C40.02 Malignant neoplasm of scapula and long bones of left upper limb
C41.2 Malignant neoplasm of vertebral column
C41.3 Malignant neoplasm of ribs, sternum and clavicle
C41.9 Malignant neoplasm of bone and articular cartilage, unspecified
C43.39 Malignant melanoma of other parts of face
C43.4 Malignant melanoma of scalp and neck
C43.51 Malignant melanoma of anal skin
C43.52 Malignant melanoma of skin of breast
C43.59 Malignant melanoma of other part of trunk
C43.60 Malignant melanoma of unspecified upper limb, including shoulder
C43.61 Malignant melanoma of right upper limb, including shoulder
C43.62 Malignant melanoma of left upper limb, including shoulder
C43.9 Malignant melanoma of skin, unspecified
C4A.71 Merkel cell carcinoma of right lower limb, including hip
C4A.9 Merkel cell carcinoma, unspecified
C44.222 Squamous cell carcinoma of skin of right ear and external auricular canal
C44.229 Squamous cell carcinoma of skin of left ear and external auricular canal
C44.329 Squamous cell carcinoma of skin of other parts of face
C44.399 Other specified malignant neoplasm of skin of other parts of face
C44.42 Squamous cell carcinoma of skin of scalp and neck
C44.49 Other specified malignant neoplasm of skin of scalp and neck
C44.501 Unspecified malignant neoplasm of skin of breast
C44.509 Unspecified malignant neoplasm of skin of other part of trunk
C44.521 Squamous cell carcinoma of skin of breast
C44.529 Squamous cell carcinoma of skin of other part of trunk
C44.599 Other specified malignant neoplasm of skin of other part of trunk
C44.622 Squamous cell carcinoma of skin of right upper limb, including shoulder
C44.629 Squamous cell carcinoma of skin of left upper limb, including shoulder
C44.709 Unspecified malignant neoplasm of skin of left lower limb, including hip
C44.90 Unspecified malignant neoplasm of skin, unspecified
C44.92 Squamous cell carcinoma of skin, unspecified
C45.7 Mesothelioma of other sites
C45.9 Mesothelioma, unspecified
C47.0 Malignant neoplasm of peripheral nerves of head, face and neck
C47.9 Malignant neoplasm of peripheral nerves and autonomic nervous system, unspecified
C48.0 Malignant neoplasm of retroperitoneum
C48.1 Malignant neoplasm of specified parts of peritoneum
C48.2 Malignant neoplasm of peritoneum, unspecified
C48.8 Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C49.0 Malignant neoplasm of connective and soft tissue of head, face and neck
C49.12 Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder
C49.5 Malignant neoplasm of connective and soft tissue of pelvis
C49.9 Malignant neoplasm of connective and soft tissue, unspecified
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.819 Malignant neoplasm of overlapping sites of unspecified female breast
C50.911 Malignant neoplasm of unspecified site of right female breast
C50.912 Malignant neoplasm of unspecified site of left female breast
C50.919 Malignant neoplasm of unspecified site of unspecified female breast
C50.921 Malignant neoplasm of unspecified site of right male breast
C50.922 Malignant neoplasm of unspecified site of left male breast
C50.929 Malignant neoplasm of unspecified site of unspecified male breast
C53.0 Malignant neoplasm of endocervix
C53.8 Malignant neoplasm of overlapping sites of cervix uteri
C53.9 Malignant neoplasm of cervix uteri, unspecified
C54.1 Malignant neoplasm of endometrium
C54.3 Malignant neoplasm of fundus uteri
C54.9 Malignant neoplasm of corpus uteri, unspecified
C55 Malignant neoplasm of uterus, part unspecified
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C56.9 Malignant neoplasm of unspecified ovary
C57.00 Malignant neoplasm of unspecified fallopian tube
C57.8 Malignant neoplasm of overlapping sites of female genital organs
C57.9 Malignant neoplasm of female genital organ, unspecified
C61 Malignant neoplasm of prostate
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C64.9 Malignant neoplasm of unspecified kidney, except renal pelvis
C65.1 Malignant neoplasm of right renal pelvis
C65.2 Malignant neoplasm of left renal pelvis
C66.1 Malignant neoplasm of right ureter
C66.2 Malignant neoplasm of left ureter
C67.1 Malignant neoplasm of dome of bladder
C67.2 Malignant neoplasm of lateral wall of bladder
C67.4 Malignant neoplasm of posterior wall of bladder
C67.5 Malignant neoplasm of bladder neck
C67.8 Malignant neoplasm of overlapping sites of bladder
C67.9 Malignant neoplasm of bladder, unspecified
C68.9 Malignant neoplasm of urinary organ, unspecified
C71.1 Malignant neoplasm of frontal lobe
C71.9 Malignant neoplasm of brain, unspecified
C73 Malignant neoplasm of thyroid gland
C74.90 Malignant neoplasm of unspecified part of unspecified adrenal gland
C74.92 Malignant neoplasm of unspecified part of left adrenal gland
C75.1 Malignant neoplasm of pituitary gland
C7A.00 Malignant carcinoid tumor of unspecified site
C7A.019 Malignant carcinoid tumor of the small intestine, unspecified portion
C7A.090 Malignant carcinoid tumor of the bronchus and lung
C7A.1 Malignant poorly differentiated neuroendocrine tumors
C7A.8 Other malignant neuroendocrine tumors
C7B.02 Secondary carcinoid tumors of liver
C7B.03 Secondary carcinoid tumors of bone
C7B.8 Other secondary neuroendocrine tumors
C76.0 Malignant neoplasm of head, face and neck
C76.2 Malignant neoplasm of abdomen
C76.3 Malignant neoplasm of pelvis
C76.51 Malignant neoplasm of right lower limb
C76.52 Malignant neoplasm of left lower limb
C76.8 Malignant neoplasm of other specified ill-defined sites
C77.0 Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck
C77.1 Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes
C77.2 Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes
C77.3 Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes
C77.4 Secondary and unspecified malignant neoplasm of inguinal and lower limb lymph nodes
C77.5 Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes
C77.8 Secondary and unspecified malignant neoplasm of lymph nodes of multiple regions
C77.9 Secondary and unspecified malignant neoplasm of lymph node, unspecified
C78.00 Secondary malignant neoplasm of unspecified lung
C78.01 Secondary malignant neoplasm of right lung
C78.02 Secondary malignant neoplasm of left lung
C78.1 Secondary malignant neoplasm of mediastinum
C78.2 Secondary malignant neoplasm of pleura
C78.4 Secondary malignant neoplasm of small intestine
C78.5 Secondary malignant neoplasm of large intestine and rectum
C78.6 Secondary malignant neoplasm of retroperitoneum and peritoneum
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
C78.80 Secondary malignant neoplasm of unspecified digestive organ
C78.89 Secondary malignant neoplasm of other digestive organs
C79.01 Secondary malignant neoplasm of right kidney and renal pelvis
C79.02 Secondary malignant neoplasm of left kidney and renal pelvis
C79.2 Secondary malignant neoplasm of skin
C79.31 Secondary malignant neoplasm of brain
C79.49 Secondary malignant neoplasm of other parts of nervous system
C79.51 Secondary malignant neoplasm of bone
C79.52 Secondary malignant neoplasm of bone marrow
C79.60 Secondary malignant neoplasm of unspecified ovary
C79.61 Secondary malignant neoplasm of right ovary
C79.62 Secondary malignant neoplasm of left ovary
C79.63 Secondary malignant neoplasm of bilateral ovaries
C79.70 Secondary malignant neoplasm of unspecified adrenal gland
C79.71 Secondary malignant neoplasm of right adrenal gland
C79.72 Secondary malignant neoplasm of left adrenal gland
C79.81 Secondary malignant neoplasm of breast
C79.82 Secondary malignant neoplasm of genital organs
C79.89 Secondary malignant neoplasm of other specified sites
C79.9 Secondary malignant neoplasm of unspecified site
C80.0 Disseminated malignant neoplasm, unspecified
C80.1 Malignant (primary) neoplasm, unspecified
C81.90 Hodgkin lymphoma, unspecified, unspecified site
C82.00 Follicular lymphoma grade I, unspecified site
C82.57 Diffuse follicle center lymphoma, spleen
C83.09 Small cell B-cell lymphoma, extranodal and solid organ sites
C83.10 Mantle cell lymphoma, unspecified site
C83.31 Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck
C84.A7 Cutaneous T-cell lymphoma, unspecified, spleen
C84.Z7 Other mature T/NK-cell lymphomas, spleen
C84.97 Mature T/NK-cell lymphomas, unspecified, spleen
C85.14 Unspecified B-cell lymphoma, lymph nodes of axilla and upper limb
C85.17 Unspecified B-cell lymphoma, spleen
C85.27 Mediastinal (thymic) large B-cell lymphoma, spleen
C85.80 Other specified types of non-Hodgkin lymphoma, unspecified site
C85.87 Other specified types of non-Hodgkin lymphoma, spleen
C85.88 Other specified types of non-Hodgkin lymphoma, lymph nodes of multiple sites
C85.97 Non-Hodgkin lymphoma, unspecified, spleen
C86.1 Hepatosplenic T-cell lymphoma
C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]
D37.6 Neoplasm of uncertain behavior of liver, gallbladder and bile ducts
D37.8 Neoplasm of uncertain behavior of other specified digestive organs
D37.9 Neoplasm of uncertain behavior of digestive organ, unspecified
D38.1 Neoplasm of uncertain behavior of trachea, bronchus and lung
D38.3 Neoplasm of uncertain behavior of mediastinum
D41.01 Neoplasm of uncertain behavior of right kidney
D48.0 Neoplasm of uncertain behavior of bone and articular cartilage
D48.1 Neoplasm of uncertain behavior of connective and other soft tissue
D48.3 Neoplasm of uncertain behavior of retroperitoneum
D48.4 Neoplasm of uncertain behavior of peritoneum
D48.5 Neoplasm of uncertain behavior of skin
D48.61 Neoplasm of uncertain behavior of right breast
D48.62 Neoplasm of uncertain behavior of left breast
D49.0 Neoplasm of unspecified behavior of digestive system
D49.1 Neoplasm of unspecified behavior of respiratory system
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
D49.3 Neoplasm of unspecified behavior of breast
D49.4 Neoplasm of unspecified behavior of bladder
D49.511 Neoplasm of unspecified behavior of right kidney
D49.512 Neoplasm of unspecified behavior of left kidney
D49.59 Neoplasm of unspecified behavior of other genitourinary organ
D49.6 Neoplasm of unspecified behavior of brain
D49.7 Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system
D49.89 Neoplasm of unspecified behavior of other specified sites
D49.9 Neoplasm of unspecified behavior of unspecified site
J91.0 Malignant pleural effusion

ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

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.

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.

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Other Coding Information

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Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2021 R7

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added C56.3 and C79.63. This revision is due to the Annual ICD-10 update and will become effective on 10/1/2021.

11/01/2019 R6

As required by CR 10901 article is converted to a formal billing and coding type article. There is no change in coverage.

05/09/2019 R5

Removed the first two bullets containing 81479 and 81540. 81540 is listed in the coding section; 81479 deleted.

Removed the following ICD-10 codes: C18.1, C22.2, C22.3, C22.4, D01.5, D01.7, D01.9, D02.21, D02.22, D03.51, D03.52, D03.59.

Added the following ICD-10 codes: C02.1, C08.9, C09.9, C11.8, C15.3, C15.4, C15.5, C15.9, C16.0, C16.2, C16.8, C16.9, C17.9, C18.0, C18.2, C18.4, C18.4, C18.7, C18.8, C22.1, C23, C24.8, C24.9, C25.0, C25.1, C26.9, C31.9, C32.0, C32.8, C34.00, C34.10, C34.30, C34.80, C34.90, C37, C38.3, C38.4, C40.01, C40.02, C41.2, C41.3, C41.9, C43.39, C43.4, C43.60, C43.61, C43.62, C43.9, C44.222, C44.229, C44.329, C44.399, C44.42, C44.49, C44.501, C44.509, C44.521, C44.529, C44.599, C44.622, C44.629, C44.709, C44.90, C44.92, C45.7, C48.1, C48.2, C48.8, C49.12, C49.5, C4A.71, C4A.9, C50.111, C50.112, C50.211, C50.212, C50.311, C50.312, C50.421, C50.422, C50.611, C50.612, C50.819, C50.919, C50.921, C50.922, C50.929, C53.0, C53.8, C53.9, C54.1, C54.3, C54.9, C55, C56.9, C57.00, C57.8, C57.9, C64.9, C65.1, C65.2, C66.1, C66.2, C67.1, C67.2, C67.4, C67.8, C68.9, C71.1, C71.9, C73, C74.90, C74.92, C75.1, C76.2, C76.3, C76.51, C76.52, C76.8, C78.00, C78.1, C78.2, C78.4, C78.80, C78.89, C79.60, C79.70, C79.71, C79.72, C79.81, C79.82, C79.9, C7A.00, C7A.019, C7A.090, C7A.1, C7A.8, C7B.02, C7B.03, C7B.8, C81.90, C82.00, C83.09, C83.10, C83.31, C85.14, C85.80, C85.88, C88.4, D37.6, D37.8, D37.9, D38.1, D38.3, D41.01, D48.0, D48.1, D48.3, D48.4, D48.5, D48.61, D48.62.

12/08/2016 R4

ICD-10 code D49.59 is added to the LCD effective 10/01/2016. The current revision effective date of 12/08/2016 is unchanged as the MCD will not allow a retroactive revision effective date prior to 12/08/2016.

12/08/2016 R3 Replaced assigned ID with DEX Z-Code™ identifier, added instruction for Part A claim submission.
10/01/2016 R2 The following revisions were made due to annual ICD-10 updates effective 10/1/16: D49.511 and D49.512 were added and D49.5 was deleted. The JFA article (A54387) is retired and Part A contract numbers are added to the Part B article. Z-Code Identifier references were replaced with unique identifier.
01/01/2016 R1 Replaced 81479 with 81540 effective 01/01/2016.

Associated Documents

Related Local Coverage Documents
LCDs
L36256 - MolDX: Molecular Diagnostic Tests (MDT)
Related National Coverage Documents
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Rules and Regulations URLs
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Public Versions
Updated On Effective Dates Status
09/03/2021 10/01/2021 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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