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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
Medicare Guidance says, As Comprehensive Genomic Profile (CGP) testing is not defined as a targeted panel 
by MolDX; and it is a test not currently satisfactorily described by any existing CPT code; to report a CGP, 
service providers should use 1-unit only of CPT code 81479 (used for the entire bundled multi-test panel) at 
this time, in addition to the approved DEX Z-CodeTM entered adjacent in the comment/narrative field for the 
test; not unbundled to separate codes, or other unlisted code. You can find this Medicare National Coverage 
Determination 90.2 Next Generation Sequencing, Medicare Local Coverage Determination L37810 Genomic 
Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms, Medicare Local Coverage 
Determination L35000 Molecular Pathology Procedures, Medicare Local Coverage Article A56199 Billing and 
Coding Molecular Pathology Procedures, Code of Federal Regulation 42 CFR 410, Subpart B - Medical and 
Other Health Services (screening tests) and Medicare Claims Processing Manual Chapter 18 - Preventive and 
Screening Services. 
 
The rules state that when completing the 1500 claim form, providers must enter the correct Place of Service 
(POS) code in section 24B. Invalid or incorrect POS codes will be denied and returned to the provider. If the 
physician bills for lab services performed in his/her office, the POS code for "Office" is shown. If the physician 
bills for a lab test furnished by another physician, who maintains a lab in his/her office, the code for "Other" is 
shown. If the physician bills for a lab service furnished by an independent lab, the code for "Independent 
Laboratory" is used. Items 21 and 22 on the Form CMS-1500 must be completed for all laboratory work 
performed outside a physician's office. If an independent lab bills, the place where the sample was taken is 
shown. An independent laboratory taking a sample in its laboratory shows "81" as place of service. If an 
independent laboratory bills for a test on a sample drawn on an inpatient or outpatient of a hospital, it uses the 
code for the inpatient (POS code 21), off campus-outpatient hospital (POS code 19), or on campus-outpatient 
hospital (POS code 22), respectively. You can find this rule at Medicare Claims Processing Manual Chapter 26 
Section 10.6. 
 The rules say that providers must report services correctly. Procedures should be reported with the CPT code 
that describes the services performed. You can find this rule in the Medicare National Correct Coding Initiative 
Manual, Chapter I. 
 
The rules say for Medicare to consider coverage and payment for any item or service, the information 
submitted by the supplier or provider must corroborate the documentation in the beneficiary's medical 
documentation and confirm that Medicare coverage criteria have been met. You can find this rule at 42 CFR 
Section 424.5. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.