MolDX: Prometheus IBD sgi Diagnostic Policy (L37313) - R9 - Effective March 13, 2025

Date Posted: October 16, 2025

This MolDX Local Coverage Determination (LCD) has been revised under contract numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

Effective Date: March 13, 2025

Summary of Changes:

Updated CMS National Coverage Policy: Title XVIII of the Social Security Act, to mirror the references used presently by the MolDX team at Palmetto GBA (PGBA) as part of an annual review. Revision history dates and language may not exactly match the MolDX PGBA revision history. However, these revisions do not change coverage or guidance.

Visit the Noridian Molecular Diagnostic Services webpage to view the Active MolDX LCD or access it via the CMS Medicare Coverage Database (MCD).

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