ModifiedColorado Rocky Mountain Health PlansPolicy MMP383.28
Molecular Pathology/Genetic Testing Reported with Unlisted Codes – Medicare Advantage Medical Policyopen_in_new
Defines reasonable and necessary coverage criteria for molecular pathology and genetic testing (including use of unlisted CPT code 81479) across multiple specific indications and aligns with CMS NCD/LCD requirements and technical assessment expectations.
Policy Summary
PayerColorado Rocky Mountain Health Plans
PolicyMolecular Pathology/Genetic Testing Reported with Unlisted Codes – Medicare Advantage Medical Policyopen_in_new
Policy CodePolicy MMP383.28
Change TypeModified (policy effective 06/01/2026; committee approval 05/13/2026)
Effective DateJun 1, 2026
Next Review DateN/A
Key ActionWhen billing with an unlisted molecular pathology code (e.g., CPT 81479), include the specific name of the laboratory test(s) and/or a short descriptor of the test(s).
SourceLink
POLICY UPDATE CHANGES
Policy lists last committee approval date May 13, 2026 and effective date June 1, 2026 indicating an updated/modified policy version.
A54272 Billing and Coding: MolDX: KIF6 Genotype marked as Retired 06/05/2025.
Removed CPT code 84999 from Applicable Codes.
Added notation that ICD-10 codes C91.00, C91.02, C92.10, and C92.12 were deleted Aug. 17, 2025 for CPT 81479 (Biomarker BCR-ABL).
Added Z85.89 for CPT code 81479 (Minimal Residual Disease Testing for Solid Tumor Cancers).
MultipleNamed tests/indications covered
NCD 90.2