Date Posted: September 24, 2026

This Billing and Coding Article has been revised under contract numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

Effective Date: Multiple Dates

Summary of Changes:

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted I42.0 and I42.8. Added I42.01, I42.09, I42.81, and I42.89. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/2026.

Under Article Text added "Specific tests that have been evaluated for compliance with coverage criteria set in policy (and are thus covered or not covered) can be found in the DEX® registry" This revision is effective 10/1/2026.

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added I42.1 and I42.2. This revision is effective 9/25/2025.

Visit the Noridian Molecular Diagnostic Services webpage to view the Active MolDX LCDs or access it via the CMS MCD.