MolDx Excluded Tests

MolDX reviews test registration applications and technical assessments (TA) to confirm that each test meets Medicare reasonable and necessary criteria. Covered tests reviewed through the TA process are identified in the Molecular Diagnostic Test policy found in the LCD section. Coding and Billing guidelines are available to facilitate reimbursement.

All LCDS are the same for each state within a Jurisdiction and are accessible from the table below.

Access LCD or Article: Select the LCD or Article number in the table below to view the policy or article on the Medicare Coverage Database (MCD).

Print the LCD or Article: Select the LCD or Article number in the table below to view the policy or article on the Medicare Coverage Database (MCD).

  1. Click on the blue download arrow on the right side of page when LCD or Article appears.
  2. Click the print when PDF opens.

Not all Local Coverage Determinations (LCDs) have an associated article(s). Not all articles are associated to an LCD.

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LCD Number MolDX LCD Title Associated Articles CPT/HCPCS Codes Referenced
L36358 MolDX: Biomarkers in Cardiovascular Risk Assessment
  • Billing and Coding: MolDX: ApoE Genotype (A55094)
  • Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing (A54975)
82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
L35710 MolDX: Circulating Tumor Cell Marker Assays
  • Billing and Coding: MolDX: Circulating Tumor Cell Marker Assays (A57815)
  • Billing and Coding: MolDX: OncoCee (A55593)
86152, 86153
L37673 MolDX: Corus® CAD Assay
  • Billing and Coding: MolDX: Corus® CAD Assay (A57415)
81493
L36155 MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR
  • Billing and Coding: MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR (A57423)
81240, 81241, 81291
L35160* MolDX: Molecular Diagnostic Tests (MDT)
  • Billing and Coding: MolDX: Abbott RealTime IDH2 testing for Acute Myeloid Leukemia (AML) (A55711)
  • Billing and Coding: MolDX: Afirma™ Assay by Veracyte (A54356)
  • Billing and Coding: MolDX: AlloMap (A54364)
  • Billing and Coding: MolDX: Avise PG Assay (A54376)
  • Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® (A54386)
  • Billing and Coding: MolDX: FDA-Approved BRAF Tests (A54418)
  • Billing and Coding: MolDX: FDA-Approved EGFR Tests (A54422)
  • Billing and Coding: MolDX: FDA-Approved KRAS Tests (A54498)
  • Billing and Coding: MolDX: HERmark Assay by Monogram (A54437)
  • Billing and Coding: MolDX: MammaPrint (A54445)
  • Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT) (A57526)
  • Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay (A54480)
  • Billing and Coding: MolDX: Oncotype DX® Colon Cancer (A54484)
  • Billing and Coding: MolDX: Progensa® PCA3 Assay (A54489)
  • Billing and Coding: MolDX: ResponseDX Tissue of Origin® (A54494)
  • Billing and Coding: MolDX: ThermoFisher Oncomine Dx Target Test For Non-Small Cell Lung Cancer (A55881)
  • Billing and Coding: MolDX: TP53 Gene Test (A55484)
  • Billing and Coding: MolDX: Vectra™ DA (A54503)
0001U, 0003U, 0004M, 0005U, 0006M, 0007M, 0008M, 0009U, 0011M, 0012M, 0012U, 0013M, 0013U, 0014U, 0016U, 0017M, 0017U, 0018U, 0019U, 0021U, 0022U, 0023U, 0024U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0039U, 0040U, 0045U, 0046U, 0047U, 0048U, 0049U, 0050U, 0053U, 0054U, 0055U, 0056U, 0057U, 0058U, 0059U, 0060U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0078U, 0079U, 0080U, 0083U, 0084U, 0087U, 0088U, 0089U, 0090U, 0091U, 0092U, 0094U, 0101U, 0102U, 0103U, 0104U, 0107U, 0108U, 0111U, 0113U, 0114U, 0118U, 0120U, 0129U, 0130U, 0131U, 0132U, 0134U, 0135U, 0136U, 0137U, 0138U, 0153U, 0154U, 0155U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0242U, 0244U, 0245U, 0246U, 81105, 81106, 81107, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81161, 81162, 81163, 81164, 81166, 81167, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81200, 81201, 81202, 81203, 81204, 81205, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81235, 81235, 81236, 81237, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81245, 81246, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81261, 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81269, 81270, 81271, 81272, 81273, 81274, 81275, 81276, 81277, 81283, 81284, 81285, 81286, 81287, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81305, 81306, 81307, 81308, 81309, 81310, 81311, 81312, 81314, 81315, 81316, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81332, 81333, 81334, 81335, 81336, 81337, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81407, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81435, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81445, 81448, 81450, 81455, 81460, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81507, 81508, 81509, 81510, 81511, 81512, 81518, 81519, 81520, 81521, 81522, 81525, 81528, 81535, 81536, 81538, 81539, 81540, 81541, 81542, 81545, 81551, 81552, 81595, 81599, 84999, 85999, 86152, 86153, 86849, 87999, 88121, 91165
L37299 MolDX: Prometheus IBD sgi Diagnostic Policy
  • Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy (A57516)
81479, 82397, 83520, 86140

 

Non LCD Related Articles

Article Number MolDX Title CPT/HCPCS Codes Referenced
A55090 Billing and Coding: MolDX: 4q25-AF Risk Genotype 81479
A55092 Billing and Coding: MolDX: 9p21 Genotype Test 81479
A55088 Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing 81200, 81412, 81443, 81479
A55097 Billing and Coding: MolDX: ATP7B Gene Tests 81406, 81443, 81479
A55099 Billing and Coding: MolDX: BCKDHB Gene Test 81205, 81406, 81443
A55113 Billing and Coding: MolDX: BLM Gene Analysis 81209, 81443
A55115 Billing and Coding: MolDX: BluePrint® 81479
A55970 Billing and Coding: MolDX: CDH1 Genetic Testing 81406
A55085 Billing and Coding: MolDX: CHD7 Gene Analysis 81407, 81479
A55181 Billing and Coding: MolDX: ENG and ACVRL1 Gene Tests 81405, 81406, 81479
A55183 Billing and Coding: MolDX: FANCC Genetic Testing 81242, 81412, 81443
A55241 Billing and Coding: MolDX: Fragile X Update 81243, 81244, 81470, 81471
A55243 Billing and Coding: MolDX: GBA Genetic Testing 81251
A55249 Billing and Coding: MolDX: HAX1 Gene Sequencing 81479
A55253 Billing and Coding: MolDX: HBB Gene Tests 81361, 81362, 81363, 81364, 81443
A55255 Billing and Coding: MolDX: HEXA Gene Analysis 81255, 81406, 81412, 81443
A55264 Billing and Coding: MolDX: HTTLPR Gene Testing 81479
A55612 Billing and Coding: MolDX: IKBKAP Genetic Testing 81260, 81412, 81443
A55272 Billing and Coding: MolDX: KIF6 Genotype 81479
A55277 Billing and Coding: MolDX: L1CAM Gene Sequencing 81407, 81470, 81471
A55279 Billing and Coding: MolDX: LPA-Aspirin Genotype 81479
A55281 Billing and Coding: MolDX: LPA-Intron 25 Genotype 81479
A55283 Billing and Coding: MolDX: MCOLN1 Genetic Testing 81290, 81412, 81443
A55285 Billing and Coding: MolDX: MECP2 Genetic Testing 81302, 81303, 81304, 81470, 81471, 81479
A55288 Billing and Coding: MolDX: MMACHC Test 81404
A55292 Billing and Coding: MolDX: myPap 84999
A55625 Billing and Coding: MolDX: PAX6 Gene Sequencing 81479
A55597 Billing and Coding: MolDX: PIK3CA Gene Tests 81309, 0155U
A55594 Billing and Coding: MolDX: PreDx® 81506
A55608 Billing and Coding: MolDX: PTCH1 Gene Testing 81479
A55610 Billing and Coding: MolDX: RPS19 Gene Tests 81405, 81479
A55623 Billing and Coding: MolDX: SETP9 Gene Test 81327
A55627 Billing and Coding: MolDX: SMPD1 Genetic Testing 81330, 81412
A55480 Billing and Coding: MolDX: STAT3 Gene Testing 81405
A55596 Billing and Coding: MolDX: SULT4A1 Genetic Testing 81479
A55611 Billing and Coding: MolDX: TERC Gene Tests 81479
A55468 Billing and Coding: MolDX: VEGFR2 Tests 81479

 

Last Updated Tue, 21 Sep 2021 14:42:02 +0000