MolDx Covered 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.

  1. To view locally hosted PDF, select applicable LCD Title OR
  2. To access CMS HTML version within Medicare Coverage Database (MCD), select applicable LCD Number

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
L37122 MolDX: 4Kscore Assay [PDF]   81539
L37358 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test [PDF]    81479
L36884 MolDX: APC and MUTYH Gene Testing [PDF]   81201, 81202, 81203, 81403, 81406, 81435, 81479
L37062 MolDX: BDX-XL2 [PDF]   81599
L36362 MolDX: Biomarkers in Cardiovascular Risk Assessment [PDF] 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
L36163 MolDX: BRCA1 and BRCA2 Genetic Testing [PDF] 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81445, 81455, 81479
L36386 MolDX: Breast Cancer Assay: Prosigna [PDF]   81520, 0008M
L37824 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test [PDF]   81518
L36329 MolDX: ConfirmMDx Epigenetic Molecular Assay [PDF]   81479
L37675 MolDX: Corus® CAD Assay [PDF]   81493
L36312 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing [PDF]   0070U, 81225, 81226, 81227, 81355, 81479
L37618 MolDX: Cystatin C Measurement [PDF]   82610
L37820 MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease [PDF]   81479
L36345 MolDX: Decipher® Prostate Cancer Classifier Assay [PDF]   81479
L37748 MolDX: DecisionDx-Melanoma [PDF]   81599
L37072 MolDX: DecisionDx-UM (Uveal Melanoma) [PDF]   0081U
L37311 MolDX: EndoPredict® Breast Cancer Gene Expression Test [PDF]   81599
L37891 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test [PDF]   81479
L36325 MolDX: GeneSight® Assay for Refractory Depression [PDF]   81479
L36186 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease [PDF] 81206, 81207, 81208, 81219, 81270, 81402, 81403, 81445, 81450, 81455, 81479
L36374 MolDX: Genetic Testing for Lynch Syndrome [PDF] 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299,81300, 81301, 81317, 81318, 81319, 81403, 81435, 81479
L36368 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay [PDF] 0047U
L37651 MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) [PDF]   81479
L36149 MolDX: HLA-B*15:02 Genetic Testing [PDF]   81381
L36544 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy [PDF]   81383
L37899 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer [PDF]   81479
L37622 MolDX:MDS FISH [PDF]   88271, 88273, 88274, 88275, 88291
L36192 MolDX: MGMT Promoter Methylation Analysis [PDF]   81287
L36256 MolDX: Molecular Diagnostic Tests (MDT) [PDF] 0002M, 0003M, 0004M, 0006M, 0007M, 0008M, 0009M, 0011M, 0012M, 0013M, 0001U, 0002U, 0003U, 0005U, 0006U, 0007U, 0008U, 0009U, 0010U, 0011U, 0012U, 0013U, 0014U, 0016U, 0017U, 0018U, 0019U, 0021U, 0022U, 0023U, 0024U, 0025U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0035U, 0036U, 0037U, 0038U, 0039U, 0040U, 0041U, 0042U, 0043U, 0044U,0070U, 81105, 81106, 81107, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 88121, 81161, 81162, 81170, 81175, 81176, 81200, 81201, 81202, 81203, 81205, 81206, 81207, 81208, 81209, 81210, 81211, 81212, 81213, 81214, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81235, 81238, 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, 81272, 81273, 81275, 81276, 81283, 81287, 81288, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81310, 81311, 81314, 81315, 81316, 81317, 81318,81319, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81330, 81331, 81332, 81334, 81335, 81340, 81341, 81342, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 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, 81445, 81448, 81450, 81455, 81460, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81507, 81508, 81509, 81510, 81511, 81512, 81519, 81520, 81521, 81525, 81528, 81535, 81536, 81538, 81539, 81540, 81541, 81545, 81551, 81595, 81599, 84999, 85999, 86152, 86153, 86849, 88120, 88121
L36171 MolDX: Molecular RBC Phenotyping [PDF]   81403
L37315 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels [PDF]   87631, 87632, 87633
L37881 MolDX: myPath Melanoma Assay [PDF]   81479
L36339 MolDX: NRAS Genetic Testing [PDF]   81311, 81479
L37744 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC) [PDF]   81479
L36947 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) [PDF]   0045U
L37321 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer [PDF]   0047U
L36891 MolDX: Percepta© Bronchial Genomic Classifier [PDF]   81479
L36350 MolDX: Prolaris™ Prostate Cancer Genomic Assay [PDF]   81541
L37082 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease [PDF]   81479
L36706 MolDX: ProMark Risk Score [PDF]   81479

 

 

Last Updated Oct 17, 2019