MolDX: Oncotype DX Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer LCD - R3

The following JE Local Coverage Determination (LCD) has been revised under contractor numbers 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV) and 01911 (HI & Territories).

Medicare Coverage Database (MCD) Number: L37305
LCD Title: MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer
Effective Date: January 1, 2019
Summary of Changes:

  • The LCD is revised to replace CPT 81479 with 0047U effective 1/1/19.
    • 0047U - Oncology (prostate), mRNA, gene expression profiling by real-time RT-PCR of 17 genes (12 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a risk score
  • The paragraph, "The AUA has recently subcategorized the intermediate-risk group into "favorable" and "unfavorable" intermediate-risk group categories. Favorable intermediate-risk are those patients with Grade Group 2 cancers (Grade Group 2 = Gleason 3+4) and PSA<10 ng/ml. Unfavorable intermediate-risk comprised men with either Grade Group 2 cancer with PSA=10-20, or any Grade Group 3 (Grade Group 3 = Gleason 4+3) with PSA<20, and clinical stage cT2b or cT2c2 "added with an effective date of 3/18/18. 

View the locally hosted Noridian Active LCD.  

  • Go to Active LCD webpage
    • The End User Agreement for Providers will appear if you have not recently visited the website. Select "Accept" (if necessary)
  • Locate above listed LCD title

Last Updated Apr 08, 2019