Molecular Test Panel Edit Alert (M00101, V4)
MolDX CPT code range affected: 81161-81408
Test Panel Definition: A predetermined set of medical tests composed of individual laboratory tests, related by medical condition, specimen type, frequency ordered, methodology or types of components to aid in the diagnosis/treatment of disease.
Palmetto considers the performance of multiple molecular biomarkers, regardless of whether the test requisition lists the tests as a panel or individually, and completed on a single sample to be a 'panel' of tests. Therefore, each panel should be registered and billed with a single CPT code and a unique MolDX identifier. Based on data analysis of MolDX claims, labs are submitting multiple biomarker 'panels' as individual tests similar to the submission of the previous stacking codes.
Example: A lab receives a patient specimen and performs the following tests:
- CPT code 81225-CYP2C19, cv
- CPT code 81240-F2, 20210G>A
- CPT code 81241-F5, Leiden
The panel of three tests listed above should be registered and claims submitted with CPT code 81479 and a single MolDX ID. If the lab also performs one of the three panel’s biomarkers on patient specimens, each biomarker must also be registered and receive a unique ID to submit on claims when only that biomarker is performed. Again, a single CPT code should be billed with a unique ID.
To correct this example, the lab must register four tests and receive identifiers for MolDX claim submission:
Test #
|
Test Name
|
Biomarkers
|
ID
|
CPT Code
|
|---|---|---|---|---|
1
|
Clotting Test Panel
|
CYP2C19, cv
F2, 20210G>A
F5, Leiden
|
Z1234
|
81479
|
2
|
CYP2C19
|
CYP2C19, cv
|
Z5678
|
81225
|
3
|
F2, 20210G>A
|
F2, 20210G>A
|
ZA234
|
81240
|
4
|
F5, Leiden
|
F5, Leiden
|
ZA567
|
81241
|
Labs should register all panels and obtain a unique MolDX identifier for each panel. If a lab does NOT perform single biomarker tests, they must notify the registry of this registration error.
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