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March 14, 2022

MolDX: Pharmacogenomics Testing Policy Article Update

The MolDX: Pharmacogenomics Testing policy (L38394) outlines limited coverage for this testing to improve safety in the use of specific medications by avoiding potentially harmful medications, doses and/or adverse reactions known to occur with certain genotypes. Documentation kept in the patient's medical record should include what drug(s) were being considered and for which indication(s).

The associated policy article, Billing and Coding: MolDX: Pharmacogenomics Testing A58324, expands on the documentation requirement under the Billing Instruction section that the drug(s) in consideration be listed in the applicable 2400 note loop. If multiple drugs need to be listed, to use forward slash (1st drug/2nd drug) to separate the drug names in the note.

To process claims for these tests more efficiently, CGS is changing the billing instructions for providers to use the underscore (1st drug_2nd drug) to separate multiple drug names in the detail note loop field.

Please begin using the underscore symbol effective for dates of service on and after April 24, 2022.

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