Active MolDX LCDs

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.

Once you access the LCD, the "Coding Guidelines" can be found under the heading, "LCD Attachments" near the end of the document. Note: All CPT/HCPCS codes listed are mentioned in the LCD, but are not necessarily subject to diagnosis codes or coverage criteria.

 
LCD Title LCD Number Billing and Coding Companion Article CPT / HCPCS Codes Referenced
MolDX: Biomarkers in Cardiovascular Risk Assessment L36358 A57037 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
MolDX: Blood Product Molecular Antigen Typing L38331 A57124 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81403, 0001U, 0084U, 0180U, 0181U, 0182U, 0183U, 0814U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0221U, 0222U
MolDX: Breast Cancer Assay: Prosigna L36380 A57363 81520
MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test L37822 A57773 81518
MolDX: Decision Dx-UM (Uveal Melanoma) L37070 A57621 81552
MolDX: EndoPredict® Breast Cancer Gene Expression Test L37295 A57607 81522
MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test L37887 A57419 81554
MolDX: Gene Expression Profile Tests for Decision-Making in Castration Resistant and Metastatic Prostate Cancers L39686 A59513 81479, 81452
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease L36180 A57421 81206, 81207, 81208, 81219, 81270, 81279, 81338, 81339, 81450, 81479, 81599, 0027U, 0040U
MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR L36155 A57423 81240, 81241, 81291
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy L36551 A57441 81383
MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer L37897 A57664 81479, 0388U
MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer L38972 A58679 81202, 81215, 81217, 81293, 81296, 81299, 81308, 81318, 81322, 81353, 81403, 81404, 81405, 81406, 81432, 81435, 81437, 81479, 0101U, 0102U, 0103U, 0129U, 81163, 81164, 81165, 81166, 81167, 81201, 81203, 81212, 81216, 81292, 81294, 81295, 81297, 81298, 81300, 81307, 81317, 81319, 81321, 81323, 81351
MolDX: Melanoma risk Stratification Molecular Testing L37750 A57268 81529
MolDX: MGMT Promoter Methylation Analysis L36188 A57432 81287
MolDX: Minimal Residual Disease Testing for Cancer L38814 A58454 81445, 81479, 0340U, 0356U, 0422U
MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma L39373 A59179 81479, 0090U, 0314U
MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneous Squamous Cell Carcinoma L39589 A59386 81479, 0315U
MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis L39467 A59521 81599
MolDX: Molecular Biomarkers for Risk Stratification of Indeterminate Pulmonary Nodules Following Bronchoscopy L39678 A59505 81479
MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer L39005 A58718 81313, 81479, 81551, 0339U, 0403U
MolDX: Molecular Diagnostic Tests (MDT) L35160* A57526 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81168, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81191, 81192, 81193, 81194, 81195, 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, 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, 81278, 81279, 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, 81313, 81314, 81315, 81316, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81332, 81333, 81334, 81335, 81336, 81337, 81338, 81339, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81347, 81348, 81349, 81350, 81351, 81352, 81353, 81355, 81357, 81360, 81361, 81362, 81363, 81364, 81374, 81377, 81381, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81419, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81434, 81435, 81437, 81439, 81440, 81441, 81442, 81443, 81445, 81448, 81449, 81450, 81451, 81455, 81456, 81460, 81465, 81470, 81471, 81479, 81493, 81504, 81507, 81515, 81518, 81519, 81520, 81521, 81522, 81523, 81525, 81528, 81529, 81540, 81541, 81542, 81546, 81551, 81552, 81554, 81558, 81595, 0004M, 0006M, 0007M, 0011M, 0012M, 0013M, 0016M, 0017M, 0020M, 0001U, 0005U, 0016U, 0017U, 0018U, 0019U, 0022U, 0023U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0036U, 0037U, 0040U, 0045U, 0046U, 0047U, 0048U, 0049U, 0050U, 0055U, 0060U, 0069U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0079U, 0084U, 0087U, 0088U, 0089U, 0090U, 0091U, 0094U, 0101U, 0102U, 0103U, 0111U, 0112U, 0113U, 0114U, 0118U, 0120U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0152U, 0153U, 0154U, 0155U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0169U, 0170U, 0171U, 0172U, 0173U, 0175U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0205U, 0209U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0221U, 0222U, 0229U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0239U, 0242U, 0244U, 0245U, 0246U, 0250U, 0258U, 0260U, 0262U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, 0282U, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0296U, 0297U, 0298U, 0299U, 0300U, 0306U, 0307U, 0313U, 0314U, 0315U, 0318U, 0319U, 0320U, 0321U, 0323U, 0326U, 0327U, 0329U, 0330U, 0331U, 0332U, 0333U, 0335U, 0336U, 0339U, 0340U, 0341U, 0347U, 0348U, 0349U, 0350U, 0355U, 0356U, 0362U, 0363U, 0439U, 0440U, 0444U, 0449U, 0452U, 0453U, 0454U, 0455U, 0460U, 0461U, 0463U, 0464U, 0465U, 0466U, 0467U, 0469U, 0470U, 0471U, 0473U, 0474U, 0475U, 0476U, 0477U, 0478U, 0480U, 0481U, 0485U, 0486U, 0487U, 0488U, 0489U, 0490U, 0491U, 0492U, 0493U, 0494U, 0495U, 0496U, 0497U, 0498U, 0499U, 0500U, 0501U, 0504U, 0505U, 0506U, 0507U, 0508U, 0509U, 0510U, 0511U, 0516U, 0523U, 0527U, 0528U, 0529U, 0530U
MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing L39001 A58720 87631, 87636, 87637, 87801, 0240U, 0241U, 87505, 87483, 87154, 81513, 81514, 81515 87800, 87801, 87999, 87632, 87633, 0115U, 0202U, 0223U, 0225U, 87149, 87150, 87153, 87506, 87507, 87468, 87469, 87471, 87472, 87475, 87476, 87478, 87480, 87481, 87482, 87484, 87485, 87486, 87487, 87490, 87491, 87492, 87493, 87495, 87496, 87497, 87498, 87501, 87502, 87503, 87510, 87511, 87512, 87513, 87516, 87517, 87520, 87521, 87522, 87523, 87525, 87526, 87527, 87528, 87529, 87530, 87531, 87532, 87533, 87534, 87535, 87536, 87537, 87538, 87539, 87540, 87541, 87542, 87550, 87551, 87552, 87555, 87556, 87557, 87560, 87561, 87562, 87563, 87564, 87580, 87581, 87582, 87590, 87591, 87592, 87593, 87594, 87623, 87624, 87625, 87626, 87634, 87635, 87640, 87641, 87650, 87651, 87652, 87653, 87660, 87661, 87662, 87797, 87798, 87799, U0001, U0002, 0109U, 0301U, 0302U, 0402U, 0429U, 0455U, 0483U, 0484U, 0502U, 0527U
MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia L39262 A59032 81479, 0114U
MolDX: Molecular Testing for Solid Organ Allograft Rejection L38629 A58168 81479, 81558, 81595, 81599, 0118U, 0508U, 0509U
MolDX: Molecular Testing for Risk Stratification of Thyroid Nodules L39682 A59509 81546, 81479
MolDX: Next-Generation Sequencing for Solid Tumors L38119 A57901 81445, 81449, 81479, 81457, 81458, 81459, 0244U, 0250U, 0334U, 0329U, 0379U
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies L38123 A57891 81450, 81451, 81479
MolDX: NRAS Genetic Testing L36335 A57486 81311, 81479
MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ L36941 A57619 0045U
MolDX: Pharmacogenomics Testing L38335 A57384 81225, 81226, 81227, 81231, 81232, 81247, 81283, 81306, 81328, 81335, 81350, 81355, 81374, 81377, 81381, 81383, 81401, 81406, 81418, 81479, 0029U, 0030U, 0034U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0286U, 0345U, 0411U, 0419U
MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells L38643 A58183 81479
MolDX: Pigmented Lesion Assay L38151 A58052 0089U
MolDX: Plasma-Based Genomic Profiling in Solid Tumors L39230 A58973 81445, 81462, 81463, 81464, 81479, 0326U, 0179U, 0409U, 0485U, 0487U
MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer L38327 A57329 81479, 0288U
MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer L38647 A58181 81401, 81403, 81404, 81445, 81479, 0016M
MolDX: Prometheus IBD sgi Diagnostic Policy L37299 A57516 81479, 82397, 83520, 86140
MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease L38339 A57372 81541, 81542, 0047U
MolDX: Repeat Germline Testing L38351 A57331 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81171, 81172, 81173, 81174, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81200, 81201, 81202, 81203, 81204, 81205, 81209, 81212, 81215, 81216, 81217, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81269, 81271, 81274, 81283, 81284, 81285, 81286, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81302, 81303, 81304, 81306, 81307, 81309, 81312, 81317, 81318, 81319, 81321, 81322, 81323, 81324, 81325, 81326, 81328, 81329, 81330, 81331, 81332, 81333, 81335, 81336, 81337, 81343, 81344, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81410, 81411, 81412, 81413, 81414, 81415, 81418, 81419, 81425, 81430, 81431, 81432, 81434, 81435, 81437, 81439, 81440, 81441, 81442, 81443, 81448, 81460, 81465, 81470, 81471, 81479, 81493, 81554, 0004M, 0001U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0079U, 0084U, 0094U, 0101U, 0102U, 0103U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0169U, 0170U, 0173U, 0175U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0205U, 0209U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0221U, 0222U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0246U, 0258U, 0260U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, 0282U, 0286U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0318U, 0345U, 0347U, 0348U, 0349U, 0350U, 0355U, 0378U, 0389U, 0392U, 0400U, 0401U, 0411U, 0417U, 0419U, 0425U, 0426U, 0439U, 0440U, 0449U, 0454U, 0460U, 0461U, 0474U, 0475U, 0477U, 0500U, 0516U, 0529U
Last Updated Jan 23 , 2025