Active MolDX LCDs

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).

  1. Click on the blue download arrow on the right side of page when LCD or Article appears.
  2. Click the print when PDF opens.

Once you access the LCD, the "Coding Guidelines" can be found under the heading, "LCD Attachments" near the end of the document. Note: All CPT/HCPCS codes listed are mentioned in the LCD, but are not necessarily subject to diagnosis codes or coverage criteria.

 
LCD Title LCD Number Billing and Coding Companion Article CPT / HCPCS Codes Referenced
MolDX: Biomarkers in Cardiovascular Risk Assessment L36362 A57055 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
MolDX: Blood Product Molecular Antigen Typing L38333 A57376 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81403, 0001U, 0084U, 0180U, 0181U, 0182U, 0183U, 0814U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0221U, 0222U
MolDX: Breast Cancer Assay: Prosigna L36386 A57364 81520
MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test L37824 A57774 81518
MolDX: Decision Dx-UM (Uveal Melanoma) L37072 A57622 81552
MolDX: EndoPredict® Breast Cancer Gene Expression Test L37311 A57608 81522
MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test L37891 A57420 81554
MolDX: Gene Expression Profile Tests for Decision-Making in Castration Resistant and Metastatic Prostate Cancers L39688 A59515 81479, 81452
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease L36186 A57422 81206, 81207, 81208, 81219, 81270, 81279, 81338, 81339, 81450, 81479, 81599, 0027U, 0040U
MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR L36159 A57424 81240, 81241, 81291
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy L36544 A57465 81383
MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer L37899 A57665 81479, 0388U
MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer L38974 A58681 81202, 81215, 81217, 81293, 81296, 81299, 81308, 81318, 81322, 81353, 81403, 81404, 81405, 81406, 81432, 81433, 81435, 81436, 81437, 81438, 81479, 0101U, 0102U, 0103U, 0129U, 81163, 81164, 81165, 81166, 81167, 81201, 81203, 81212, 81216, 81292, 81294, 81295, 81297, 81298, 81300, 81307, 81317, 81319, 81321, 81323, 81351
MolDX: Melanoma risk Stratification Molecular Testing L37748 A57290 81529
MolDX: MGMT Promoter Methylation Analysis L36192 A57433 81287
MolDX: Minimal Residual Disease Testing for Cancer L38816 A58456 81445, 81479, 0340U, 0356U, 0422U
MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma L39375 A59181 81479, 0090U, 0314U
MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneous Squamous Cell Carcinoma L39594 A59401 81479, 0315U
MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis L39469 A59522 81599, 0456U
MolDX: Molecular Biomarkers for Risk Stratification of Indeterminate Pulmonary Nodules Following Bronchoscopy L39680 A59507 81479
MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer L39007 A58724 81313, 81479, 81551, 0005U, 0339U, 0403U
MolDX: Molecular Diagnostic Tests (MDT) L36256* A57527 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81168, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81191, 81192, 81193, 81194, 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, 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, 81278, 81279, 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, 81313, 81314, 81315, 81316, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81332, 81333, 81334, 81335, 81336, 81337, 81338, 81339, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81347, 81348, 81349, 81350, 81351, 81352, 81353, 81355, 81357, 81360, 81361, 81362, 81363, 81364, 81374, 81377, 81381, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81419, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81441, 81442, 81443, 81445, 81448, 81449, 81450, 81451, 81455, 81456, 81460, 81465, 81470, 81471, 81479, 81493, 81504, 81507, 81518, 81519, 81520, 81521, 81522, 81523, 81525, 81528, 81529, 81540, 81541, 81542, 81546, 81551, 81552, 81554, 81595, 0004M, 0006M, 0007M, 0011M, 0012M, 0013M, 0016M, 0017M, 0020M, 0001U, 0005U, 0016U, 0017U, 0018U, 0019U, 0022U, 0023U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0036U, 0037U, 0040U, 0045U, 0046U, 0047U, 0048U, 0049U, 0050U, 0055U, 0060U, 0069U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0079U, 0084U, 0087U, 0088U, 0089U, 0090U, 0091U, 0094U, 0101U, 0102U, 0103U, 0111U, 0112U, 0113U, 0114U, 0118U, 0120U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0152U, 0153U, 0154U, 0155U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0169U, 0170U, 0171U, 0172U, 0173U, 0175U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0205U, 0209U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0221U, 0222U, 0229U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0239U, 0242U, 0244U, 0245U, 0246U, 0250U, 0258U, 0260U, 0262U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, 0282U, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0296U, 0297U, 0298U, 0299U, 0300U, 0306U, 0307U, 0313U, 0314U, 0315U, 0318U, 0319U, 0320U, 0321U, 0323U, 0326U, 0327U, 0329U, 0330U, 0331U, 0332U, 0333U, 0335U, 0336U, 0339U, 0340U, 0341U, 0347U, 0348U, 0349U, 0350U, 0355U, 0356U, 0362U, 0363U, 0439U, 0440U, 0444U, 0448U, 0449U, 0452U, 0453U, 0454U, 0455U, 0456U, 0460U, 0461U, 0463U, 0464U, 0465U, 0466U, 0467U, 0469U, 0470U, 0471U, 0473U, 0474U, 0475U, 0476U, 0477U, 0478U, 0480U, 0481U, 0485U, 0486U, 0487U, 0488U, 0489U, 0490U, 0491U, 0492U, 0493U, 0494U, 0495U, 0496U, 0497U, 0498U, 0499U, 0500U, 0501U, 0504U, 0505U, 0506U, 0507U, 0508U, 0509U, 0510U, 0511U, 0516U
MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing L39003 A58726 87631, 87636, 87637, 87801, 0240U, 0241U, 87505, 87483, 87154, 81513, 81514, 87800, 87801, 87999, 0352U, 87632, 87633, 0115U, 0202U, 0223U, 0225U, 87149, 87150, 87153, 87506, 87507, 87468, 87469, 87471, 87472, 87475, 87476, 87478, 87480, 87481, 87482, 87484, 87485, 87486, 87487, 87490, 87491, 87492, 87493, 87495, 87496, 87497, 87498, 87501, 87502, 87503, 87510, 87511, 87512, 87516, 87517, 87520, 87521, 87522, 87523, 87525, 87526, 87527, 87528, 87529, 87530, 87531, 87532, 87533, 87534, 87535, 87536, 87537, 87538, 87539, 87540, 87541, 87542, 87550, 87551, 87552, 87555, 87556, 87557, 87560, 87561, 87562, 87563, 87580, 87581, 87582, 87590, 87591, 87592, 87593, 87623, 87624, 87625, 87634, 87635, 87640, 87641, 87650, 87651, 87652, 87653, 87660, 87661, 87662, 87797, 87798, 87799, U0001, U0002, 0109U, 0301U, 0302U, 0402U, 0429U, 0455U, 0483U, 0484U, 0502U
MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasias L39264 A59034 81479, 0114U
MolDX: Molecular Testing for Solid Organ Allograft Rejection L38671 A58170 81479, 81595, 81599, 0118U, 0508U, 0509U
MolDX: Molecular Testing for Risk Stratification of Thyroid Nodules L39684 A59511 81546, 81479
MolDX: Next-Generation Sequencing for Solid Tumors L38121 A57905 81445, 81449, 81479, 81457, 81458, 81459, 0244U, 0250U, 0329U, 0334U, 0379U
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies L38125 A57892 81450, 81451, 81479
MolDX: NRAS Genetic Testing L36339 A57487 81311, 81479
MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ L36947 A57620 0045U
MolDX: Pharmacogenomics Testing L38337 A57385 81225, 81226, 81227, 81231, 81232, 81247, 81283, 81306, 81328, 81335, 81350, 81355, 81374, 81377, 81381, 81383, 81401, 81406, 81418, 81479, 0029U, 0030U, 0034U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0286U, 0345U, 0380U, 0411U, 0419U
MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells L38645 A58185 81479
MolDX: Pigmented Lesion Assay L38153 A58053 0089U
MolDX: Plasma-Based Genomic Profiling in Solid Tumors L39232 A58975 81445, 81479, 0326U, 0179U, 0409U, 0428U, 0485U, 0487U
MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer L38329 A57330 81479, 0288U
MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer L38649 A58187 81401, 81403, 81404, 81445, 81479, 0016M
MolDX: Prometheus IBD sgi Diagnostic Policy L37313 A57517 81479, 82397, 83520, 86140
MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease L38341 A57236 81541, 81542, 0047U
MolDX: Repeat Germline Testing L38353 A57332 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81171, 81172, 81173, 81174, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81200, 81201, 81202, 81203, 81204, 81205, 81209, 81212, 81215, 81216, 81217, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81269, 81271, 81274, 81283, 81284, 81285, 81286, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81302, 81303, 81304, 81306, 81307, 81309, 81312, 81317, 81318, 81319, 81321, 81322, 81323, 81324, 81325, 81326, 81328, 81329, 81330, 81331, 81332, 81333, 81335, 81336, 81337, 81343, 81344, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81410, 81411, 81412, 81413, 81414, 81415, 81418, 81419, 81425, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81441, 81442, 81443, 81448, 81460, 81465, 81470, 81471, 81479, 81493, 81554, 0004M, 0001U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0079U, 0084U, 0094U, 0101U, 0102U, 0103U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0169U, 0170U, 0173U, 0175U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0205U, 0209U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0221U, 0222U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0246U, 0258U, 0260U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, 0282U, 0286U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0318U, 0345U, 0347U, 0348U, 0349U, 0350U, 0355U, 0378U, 0380U, 0389U, 0392U, 0400U, 0401U, 0411U, 0417U, 0419U, 0425U, 0426U, 0439U, 0440U, 0449U, 0454U, 0460U, 0461U, 0474U, 0475U, 0477U, 0500U, 0516U
Last Updated Dec 03 , 2024