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 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).
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