MolDX Excluded Tests - JF Part A
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).
- Click on the blue download arrow on the right side of page when LCD or Article appears.
- 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 |
|---|---|---|---|
| L36362 | MolDX: Biomarkers in Cardiovascular Risk Assessment | 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141 | |
| L34066 | MolDX: Circulating Tumor Cell Marker Assays | 86152, 86153 | |
| L37675 | MolDX: Corus® CAD Assay |
|
81493 |
| L36159 | MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR |
|
81240, 81241, 81291 |
| L36256 | MolDX: Molecular Diagnostic Tests (MDT) |
|
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 |
| L37313 | MolDX: Prometheus IBD sgi Diagnostic Policy |
|
81479, 82397, 83520, 86140 |
Non LCD Related Articles
| Article Number | MolDX Title | CPT/HCPCS Codes Referenced |
|---|---|---|
| A55091 | Billing and Coding: MolDX: 4q25-AF Risk Genotype | 81479 |
| A55093 | Billing and Coding: MolDX: 9p21 Genotype Test | 81479 |
| A55089 | Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing | 81200, 81412, 81443, 81479 |
| A55098 | Billing and Coding: MolDX: ATP7B Gene Tests | 81406, 81443, 81479 |
| A55100 | Billing and Coding: MolDX: BCKDHB Gene Test | 81205, 81406, 81443 |
| A55114 | Billing and Coding: MolDX: BLM Gene Analysis | 81209, 81443 |
| A55116 | Billing and Coding: MolDX: BluePrint® | 81479 |
| A55971 | Billing and Coding: MolDX: CDH1 Genetic Testing | 81406 |
| A55182 | Billing and Coding: MolDX: ENG and ACVRL1 Gene Tests | 81405, 81406, 81479 |
| A55184 | Billing and Coding: MolDX: FANCC Genetic Testing | 81242, 81412, 81443 |
| A55242 | Billing and Coding: MolDX: Fragile X Update | 81243, 81244, 81470, 81471 |
| A55244 | Billing and Coding: MolDX: GBA Genetic Testing | 81251 |
| A55252 | Billing and Coding: MolDX: HAX1 Gene Sequencing | 81479 |
| A55254 | Billing and Coding: MolDX: HBB Gene Tests | 81361, 81362, 81363, 81364, 81443 |
| A55256 | Billing and Coding: MolDX: HEXA Gene Analysis | 81255, 81406, 81412, 81443 |
| A55265 | Billing and Coding: MolDX: HTTLPR Gene Testing | 81479 |
| A55613 | Billing and Coding: MolDX: IKBKAP Genetic Testing | 81260, 81412, 81442 |
| A55273 | Billing and Coding: MolDX: KIF6 Genotype | 81479 |
| A55278 | Billing and Coding: MolDX: L1CAM Gene Sequencing | 81407, 81470, 81471 |
| A55280 | Billing and Coding: MolDX: LPA-Aspirin Genotype | 81479 |
| A55282 | Billing and Coding: MolDX: LPA-Intron 25 Genotype | 81479 |
| A55284 | Billing and Coding: MolDX: MCOLN1 Genetic Testing | 81290, 81412, 81443 |
| A55286 | Billing and Coding: MolDX: MECP2 Genetic Testing | 81302, 81303, 81304, 81470, 81471, 81479 |
| A55289 | Billing and Coding: MolDX: MMACHC Test | 81404 |
| A55293 | Billing and Coding: MolDX: myPap | 84999 |
| A55632 | Billing and Coding: MolDX: PAX6 Gene Sequencing | 81479 |
| A55602 | Billing and Coding: MolDX: PIK3CA Gene Tests | 81309, 0155U |
| A55599 | Billing and Coding: MolDX: PreDx® | 81506 |
| A55618 | Billing and Coding: MolDX: PTCH1 Gene Testing | 81479 |
| A55614 | Billing and Coding: MolDX: RPS19 Gene Tests | 81405, 81479 |
| A55628 | Billing and Coding: MolDX: SETP9 Gene Test | 81327 |
| A55631 | Billing and Coding: MolDX: SMPD1 Genetic Testing | 81330, 81412 |
| A55481 | Billing and Coding: MolDX: STAT3 Gene Testing | 81405 |
| A55601 | Billing and Coding: MolDX: SULT4A1 Genetic Testing | 81479 |
| A55616 | Billing and Coding: MolDX: TERC Gene Tests | 81479 |
| A55469 | Billing and Coding: MolDX: VEGFR2 Tests | 81479 |
| A55086 | MolDX: CHD7 Gene Analysis Coding and Billing Guidelines | 81407, 81479 |
Last Updated Tue, 21 Sep 2021 14:42:16 +0000