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.

  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
L36362 MolDX: Biomarkers in Cardiovascular Risk Assessment [PDF] 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
L34066 MolDX: Circulating Tumor Cell Marker Assays [PDF] 86152, 86153
L37675 MolDX: Corus® CAD Assay [PDF] 81493
L36159 MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR [PDF] 81240, 81241, 81291
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
L37313 MolDX: Prometheus IBD sgi Diagnostic Policy [PDF] 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 Billing and Coding Guidelines [PDF] 81479
A55093 Billing and Coding: MolDX: 9p21 Genotype Test Billing and Coding Guidelines [PDF] 81479
A55089

Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing Billing and Coding Guidelines [PDF]

81200, 81412, 81443, 81479
A55098 Billing and Coding: MolDX: ATP7B Gene Tests Billing and Coding Guidelines [PDF] 81406, 81443, 81479
A55100 Billing and Coding: MolDX: BCKDHB Gene Test Billing and Coding Guidelines [PDF] 81205, 81406, 81443
A55114 Billing and Coding: MolDX: BLM Gene Analysis Billing and Coding Guidelines [PDF] 81209, 81443
A55116 Billing and Coding: MolDX: BluePrint® Billing and Coding Guidelines [PDF] 81479
A55971 Billing and Coding: MolDX: CDH1 Genetic Testing Billing and Coding Guidelines [PDF] 81406
A55118 Billing and Coding: MolDX: CFTR Gene Analysis Coding and Billing Guidelines [PDF] 81220, 81221, 81222, 81223, 81224, 81412, 81443, 81479
A55178 Billing and Coding: MolDX: CYP2B6 Test Billing and Coding Guidelines [PDF] 81479
A55182 Billing and Coding: MolDX: ENG and ACVRL1 Gene Tests Billing and Coding Guidelines [PDF] 81405, 81406, 81479
A55184 Billing and Coding: MolDX: FANCC Genetic Testing Billing and Coding Guidelines [PDF] 81242, 81412, 81443
A55242 Billing and Coding: MolDX: Fragile X Billing and Coding Guidelines Update [PDF] 81243, 81244, 81470, 81471
A55244 Billing and Coding: MolDX: GBA Genetic Testing Billing and Coding Guidelines [PDF] 81251
A55252 Billing and Coding: MolDX HAX1 Gene Sequencing Billing and Coding Guidelines [PDF] 81479
A55254 Billing and Coding: MolDX: HBB Gene Tests Billing and Coding Guidelines [PDF] 81361, 81362, 81363, 81364, 81443
A55256

Billing and Coding: MolDX: HEXA Gene Analysis Billing and Coding Guidelines [PDF]

81255, 81406, 81412, 81443
A55265 Billing and Coding: MolDX: HTTLPR Gene Testing Billing and Billing Guidelines Guidelines [PDF] 81479
A55613

Billing and Coding: MolDX: IKBKAP Genetic Testing Billing and Coding Guidelines [PDF]

81260, 81412, 81442
A55273 Billing and Coding: MolDX: KIF6 Genotype Billing and Coding Guidelines [PDF] 81479
A55280 Billing and Coding: MolDX: LPA-Aspirin Genotype Billing and Coding Guidelines [PDF] 81479
A55282 Billing and Coding: MolDX: LPA-Intron 25 Genotype Billing and Coding Guidelines [PDF] 81479
A55284 Billing and Coding: MolDX: MCOLN1 Genetic Testing Billing and Coding Guidelines [PDF] 81290, 81412, 81443
A55286 Billing and Coding: MolDX: MECP2 Genetic Testing [PDF] 81302, 81303, 81304, 81470, 81471, 81479
A55289 Billing and Coding: MolDX: MMACHC Test Billing and Coding Guidelines [PDF] 81404
A55293 Billing and Coding: MolDX: myPap Billing and Coding Guidelines [PDF] 84999
A55632 Billing and Coding: MolDX: PAX6 Gene Sequencing [PDF] 81479
A55602 Billing and Coding: MolDX: PIK3CA Gene Tests Billing and Coding Guidelines [PDF] 81309, 0155U
A55599

Billing and Coding: MolDX: PreDx® Billing and Coding Guidelines [PDF]

81506
A55618

Billing and Coding: MolDX: PTCH1 Gene Testing Billing and Coding Guidelines [PDF]

81479
A55614 Billing and Coding: MolDX: RPS19 Gene Tests Billing and Coding Guidelines [PDF] 81405, 81479
A55628 Billing and Coding: MolDX: SETP9 Gene Test Billing and Coding Guidelines [PDF] 81327
A55630 Billing and Coding: MolDX: SLCO1B1 Genotype Billing and Coding Guidelines [PDF] 81328
A55631 Billing and Coding: MolDX: SMPD1 Genetic Testing Billing and Coding [PDF] 81330, 81412
A55481 Billing and Coding: MolDX: STAT3 Gene Testing Billing and Coding Guidelines [PDF] 81405
A55601

Billing and Coding: MolDX: SULT4A1 Genetic Testing Billing and Coding Guidelines [PDF]

81479
A55616 Billing and Coding: MolDX: TERC Gene Tests Billing and Coding Guidelines [PDF] 81479
A55483 Billing and Coding: MolDX: UGT1A1 Gene Analysis Billing and Coding Guidelines [PDF] 81350
A55469 Billing and Coding: MolDX: VEGFR2 Tests Coding and Billing Guidelines [PDF] 81479
A55086 MolDX: CHD7 Gene Analysis Coding and Billing Guidelines [PDF] 81407, 81479
A55277 MolDX: L1CAM Gene Sequencing Billing and Coding Guidelines [PDF] 81407, 81470, 81471

 

Last Updated Apr 03, 2020