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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. 
 
The rules say that if one laboratory procedure evaluates multiple genes using a next generation sequencing 
procedure, the laboratory shall report only one unit of service of one genomic sequencing procedure, molecular 
multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis CPT code. 
If no CPT code accurately describes the procedure performed, the laboratory may report CPT code 81479 
(Unlisted molecular pathology procedure) with one unit of service or may report multiple individual CPT codes 
describing the component test results when medically reasonable and necessary. Procedures reported together 
must be both medically reasonable and necessary (e.g., sequencing of procedures) and ordered by the physician 
who is treating the beneficiary and using the results in the management of the beneficiary's specific medical 
problem. You can find this information in Chapter X: Pathology/Laboratory Services (CPT codes 80000-8999) 
for National Correct Coding Initiative Policy Manual for Medicare Services. 
 
The rules say all the following must be present for coverage eligibility: 
 
The patient must have 
Any cancer diagnosis 
AND a clinical indication for germline (inherited) testing for hereditary cancer 
AND a risk factor for germline (inherited) cancer 
AND has not been previously tested with the same germline genetic content. 
The test has satisfactorily completed a Technical Assessment (TA) by Molecular Diagnostic Services Program 
(MolDX) for the stated indications of the test. 
 The test performed includes at least the minimum genetic content (genes or genetic variants) with definitive or 
well-established guidelines-based evidence required for clinical decision making for its intended use that can 
be reasonably detected by the test. 
Because these genes and variants will change as the literature and drug indications evolve, they are listed 
separately in associated documents, such as the MolDX TA forms. 
 A single gene or variant may be tested if it is the only gene or variant considered to be reasonable and 
necessary for a cancer type. If a previous test was performed with a similar/duplicative intended use, a subsequent test is only reasonable 
and necessary if the non-duplicative genetic content of the second test is reasonable and necessary. 
If the test is an NGS test, it must abide by all conditions listed in the NCD 90.2. You can find this information 
in Medicare's Local Coverage Determination (LCD): MolDX: Lab-Developed Tests for Inherited Cancer 
Syndromes in Patients with Cancer (L38972). 
 
The rules say that in general 2 or more codes describing a genetic test billed on the same beneficiary on the 
same date may constitute a panel, and if so the service must be billed as a single procedural service. We would 
generally expect that a provider or supplier would not bill for more than 1 distinct laboratory genetic testing 
procedural services on a single beneficiary on a single date of service. If providers or suppliers do bill for more 
than 1 distinct laboratory genetic testing procedural services on a single beneficiary on a single date of service, 
the provider or supplier must attest that each additional service billed is a distinct procedural service using the 
59 modifier. You can find this information in the Medicare Local Coverage Article Billing and Coding: Billing 
and Coding: MolDX: Testing of Multiple Genes (A57880). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.