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
L36163 MolDX: BRCA1 and BRCA2 Genetic Testing [PDF] 81162, 81211, 81212, 81213, 81214, 81215, 81216, 81217, 81432, 81445, 81455, 81479
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 L37313

 

Non LCD Related Articles

Article Number MolDX Title CPT/HCPCS Codes Referenced
A55091 MolDX: 4q25-AF Risk Genotype Billing and Coding Guidelines [PDF] 81479
A55093 MolDX: 9p21 Genotype Test Billing and Coding Guidelines [PDF] 81479
A55089

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

81200, 81412, 81479
A55098 MolDX: ATP7B Gene Tests Billing and Coding Guidelines [PDF] 81406, 81479
A55100 MolDX: BCKDHB Gene Test Billing and Coding Guidelines [PDF]  81205, 81406
A55114 MolDX: BLM Gene Analysis Billing and Coding Guidelines [PDF] 81209
A55116 MolDX: BluePrint® Billing and Coding Guidelines [PDF] 81479
A55971 MolDX: CDH1 Genetic Testing Billing and Coding Guidelines [PDF] 81406
A55118 MolDX: CFTR Gene Analysis Coding and Billing Guidelines [PDF] 81220, 81221, 81222, 81223, 81224, 81412, 81443, 81479
A55086 MolDX: CHD7 Gene Analysis Coding and Billing Guidelines [PDF] 81407, 81479
A55178 MolDX: CYP2B6 Test Billing and Coding Guidelines [PDF] 81479
A55182 MolDX: ENG and ACVRL1 Gene Tests Billing and Coding Guidelines [PDF] 81405, 81406, 81479
A55184 MolDX: FANCC Genetic Testing Billing and Coding Guidelines [PDF] 81242, 81412, 81443
A55242 MolDX: Fragile X Billing and Coding Guidelines Update [PDF] 81243, 81244, 81470, 81471
A55244 MolDX: GBA Genetic Testing Billing and Coding Guidelines [PDF] 81251
A55252 MolDX HAX1 Gene Sequencing Billing and Coding Guidelines [PDF] 81479
A55254 MolDX: HBB Gene Tests Billing and Coding Guidelines [PDF] 81361, 81362, 81363, 81364, 81443
A55256

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

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

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

81260, 81412, 81442
A55273 MolDX: KIF6 Genotype Billing and Coding Guidelines [PDF] 81479
A55277 MolDX: L1CAM Gene Sequencing Billing and Coding Guidelines [PDF] 81407, 81470, 81471
A55280 MolDX: LPA-Aspirin Genotype Billing and Coding Guidelines [PDF] 81479
A55282 MolDX: LPA-Intron 25 Genotype Billing and Coding Guidelines [PDF] 81479
A55284 MolDX: MCOLN1 Genetic Testing Billing and Coding Guidelines [PDF] 81290, 81412, 81443
A55286 MolDX: MECP2 Genetic Testing Billing and Coding Guidelines [PDF] 81302, 81303, 81304, 81470, 81471, 81479
A55289 MolDX: MMACHC Test Billing and Coding Guidelines [PDF] 81404
A55293 MolDX: myPap Billing and Coding Guidelines [PDF] 84999
A55632 MolDX: PAX6 Gene Sequencing Billing and Coding Guidelines [PDF] 81479
A55602 MolDX: PIK3CA Gene Tests Billing and Coding Guidelines [PDF] 81404
A55599

MolDX: PreDx® Billing and Coding Guidelines [PDF]

81506
A55618

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

81479
A55614 MolDX: RPS19 Gene Tests Billing and Coding Guidelines [PDF] 81403, 81405, 81479
A55628 MolDX: SETP9 Gene Test Billing and Coding Guidelines [PDF] 81327
A55630 MolDX: SLCO1B1 Genotype Billing and Coding Guidelines [PDF] 81328
A55631 MolDX: SMPD1 Genetic Testing Billing and Coding [PDF] 81330, 81403
A55481 MolDX: STAT3 Gene Testing Billing and Coding Guidelines [PDF] 81405
A55601

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

81479
A55616 MolDX: TERC Gene Tests Billing and Coding Guidelines [PDF] 81479
A55483 MolDX: UGT1A1 Gene Analysis Billing and Coding Guidelines [PDF] 81350
A55469 MolDX: VEGFR2 Tests Coding and Billing Guidelines [PDF] 81479

 

Last Updated Jul 31, 2019