American Samoa
Guam
Hawaii
Northern Mariana Islands
01212 - A and B MAC
American Samoa
Guam
Hawaii
Northern Mariana Islands
01311 - A and B MAC
Nevada
01312 - A and B MAC
Nevada
01911 - A and B MAC
American Samoa
California - Entire State
Guam
Hawaii
Nevada
Northern Mariana Islands
Article Information
Article ID Number: A59835 Status: A-Approved
Article Title: Billing and Coding: MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms
Original Article Effective Date:
08/17/2025
Revision Effective Date:
Article Text:
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms L39923.
Tests performed by next generation sequencing (NGS) must demonstrate compliance with L38123 MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies and its accompanying billing and coding article, A57891 Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies.
See also the following Relevant Articles: A58120 Billing and Coding: MolDX: Testing of Multiple Genes, A55624 Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer, and A55595 Billing and Coding: MolDX: BCR-ABL.
NOTES:
The performance of a multi-gene panel test by NGS or any other method (including multiplex PCR) must be billed as a panel test. A panel is a single unit of service and cannot be unbundled into individual components. Testing of individual genes by a non-NGS method (i.e. single-gene PCR) in a sequential and reflexive manner is compliant with policy, if all LCD criteria are met.
As noted in the LCD, this approach may be followed by an NGS panel test in select circumstances according to the specific criteria outlined therein.
The unit of service for each of the CPT/PLA codes listed below is limited to once per lifetime for a given diagnosis. It is also not appropriate to bill the single gene tests sequentially and a non-NGS panel for the same intended use.
Billing for BCR-ABL testing must comply with A55595, Billing and Coding: MolDX: BCR-ABL.
To report a service for Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms, 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
Item19 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
Select the appropriate ICD-10-CM code
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.
Coding Information
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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
