LCD Reference Article Billing and Coding Article

Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®

A54188

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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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General Information

Source Article ID
N/A
Article ID
A54188
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/01/2024
Revision Ending Date
N/A
Retirement Date
N/A

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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.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

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

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

Effective November 19, 2012, Cancer TYPE ID, an RT-PCR 92-gene assay, has been assigned a DEX Z-Code™ identifier. To bill for Cancer TYPE ID, please provide the following claim information:

  • CPT code: 81540- Oncology (tumor of unknown origin) mRNA gene expression of 92 genes
  • Enter “1” in the Days/Unit field
  • Enter “DEX Z-Code™ Identifier” in the comment/narrative field for the following claim field/types:
    • Loop 2300 NTE01/SV202-7 for Part A or SV101-7 field for Part B
    • Submit “DEX Z-Code™ Identifier” on an attachment to the claim form for paper claim (Form locator 80 for Part A or Box 19 for Part B
  •  Select the appropriate ICD-10-CM code:

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

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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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

Group 1

(253 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
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
C56.9 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
C79.70 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
C83.390 Primary central nervous system lymphoma
C83.398 Diffuse large B-cell lymphoma of other extranodal and solid organ sites
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
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
D48.3 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
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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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

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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

Group 1

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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
10/01/2024 R22

Revision Effective: 10/01/2024

Revision Explanation: Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted C86.1 and C88.4. Added C83.390 and C83.398. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/2024.

11/16/2023 R21

Revision Effective: 11/16/2023

Revision Explanation: Updated LCD Reference Article section.

10/01/2023 R20

Revision Effective: 10/01/2023

Revision Explanation: Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted D48.1. This revision is due to the Annual ICD-10-CM Update and will become 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.

06/01/2023 R19

Revision Effective date: 06/01/2023
Revision Explanation: Under CMS National Coverage Policy added regulations, Title XVIII of the Social Security Act, §1833(e), CMS Internet-Only Manuals, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 A/B MAC (B) Contacts With Independent Clinical Laboratories, 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, and CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §10 Reporting ICD Diagnosis and Procedure Codes.

 

10/03/2019 R18

Revision Effective date: N/A
Revision Explanation: Annual review no changes made.

10/03/2019 R17

Revision Effective date: 10/03/2019
Revision Explanation: Converted article into new billing and coding article template.

05/09/2019 R16

Revision Effective date: 05/09/2019
Revision Explanation:ICD-10 codes C15.5 and C34.80 were inadvertently left off of the revision history for Revision 15. They are applicable for 81540 effective 5/9/19.

05/09/2019 R15

Revision Effective date: 05/09/2019
Revision Explanation: Codes C44.329 and C7A.090 were left out in error when they should have been added from revision 13. Also C22.3 was left in error and should have been removed during revision 13.

05/09/2019 R14

Revision Effective date: 05/09/2019
Revision Explanation: The following codes were left off in error and have been added:C44.229, C50.311, C50.421, C50.612, C50.921, C65.2, C66.1, C76.52, D48.62

05/09/2019 R13

Revision Effective date: 05/09/2019
Revision Explanation:

Removed the first bullet that lists CPT code 81479. 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, C15.9, 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, C34.90, 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, C44.329, 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, C50.312, C50.422, C50.611, C50.819, C50.919, 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, 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, C76.8, 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

12/08/2016 R12

Revision Effective date: N/A
Revision Explanation: Annual review no changes made.

12/08/2016 R11

Revision Effective:10/01/2016

Revision Explanation: Added D49.59 to list of ICD-10 codes as it was left off in error..

 

 

 

 

10/01/2015 R10

Revision Effective date: N/A
Revision Explanation: Annual review no changes made

12/08/2016 R9 Revision Effective date: 12/08/2016
Revision Explanation: Replaced assigned ID with DEX Z-Code™ identifier
10/01/2015 R8 Revision Effective date: N/A
Revision Explanation: Annual review no changes made.
10/01/2016 R7 Revision Effective: 10/01/2016
Revision Explanation: During annual ICD-10 update D49.5 was deleted and replaced with D49.511 and D49.512.
01/01/2016 R6 Revision Effective: 01/01/2016
REvision Explanation: Added Correct 2016 CPT code in the CPT/HCPCS section to correspond to what was listed in the text.
10/01/2015 R5 Revision Effective: 10/01/2015
Revision explanation: Changed MolDX ID field to SV101-7 and Z-code to ZCode™ Identifier.
10/01/2015 R4 Revision Effective: 10/01/2015
Revision Explanation: Added the information for Part B concerning the new MolDX identifier field and new 2016 code 81540.
10/01/2015 R3 Revision Effective: N/A
Revision Explanation: Annual review no changes made.
10/01/2015 R2 R1
Revision Effective:10/01/2015
Revision Explanation: Changed MoPath to MolDX.
10/01/2015 R1 Revision Effective: 10/01/2015
Revision Effective: Corrected to say enter assigned ID in comment/narrative field on claim and added Part A information.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L36021 - MolDX: Molecular Diagnostic Tests (MDT)
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