September 22, 2015
Molecular Test Panel Edit Alert (CM00005)
Revised with new edit start date.
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.
CGS Administrators and the MolDX contractor 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 panels’ 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 |
Z1234 |
81479 |
2 |
CYP2C19 |
CYP2C19, cv |
Z5678 |
81225 |
3 |
F2, 20210G>A |
F2, 20210G>A |
ZA234 |
81240 |
4 |
F5, Leiden |
F5, Leiden |
ZA567 |
81241 |
Effective November 9, 2015, labs should start to 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.
MolDX Panel Plan Timeline:
- Effective 10/09/2015, CGS Administrators will start lab notification. Labs that have submitted panel test claims will need a MolDX ID.
- Labs will have a 30 day grace period
- Effective 11/09/2015, CGS- MolDX will set edits to reject tests performed as panels and registered and submitted with a CPT code for each biomarker in the panel