MolDx Covered 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).

  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.

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
L37122 MolDX: 4Kscore Assay
  • Billing and Coding: MolDX: 4K Score Assay (A57337)
81539
L36884 MolDX: APC and MUTYH Gene Testing
  • Billing and Coding: MolDX: APC and MUTYH Gene Testing (A57353)
81201, 81202, 81203, 81401, 81403, 81406, 81435, 81436, 81479
L37062 MolDX: BDX-XL2
  • Billing and Coding: MolDX: BDX-XL2 (A57357)
0080U
L36362 MolDX: Biomarkers in Cardiovascular Risk Assessment
  • Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment (A57055)
  • Billing and Coding: MolDX: ApoE Genotype (A55095)
  • Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing (A54976)
81401, 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141
L36163 MolDX: BRCA1 and BRCA2 Genetic Testing
  • Billing and Coding: MolDX: BRCA1 and BRCA2 Genetic Testing (A57355)
  • Billing and Coding: MolDX: Myriad's BRACAnalysis CDx™ (A55295)
81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433, 81445, 81455, 81479, 0102U, 0103U, 0129U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U
L36386 MolDX: Breast Cancer Assay: Prosigna
  • Billing and Coding: MolDX: Breast Cancer Assay: Prosigna (A57364)
81520
L37824 MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test
  • Billing and Coding: MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test (A57774)
81518
L36329 MolDX: ConfirmMDx Epigenetic Molecular Assay
  • Billing and Coding: MolDX: ConfirmMDx Epigenetic Molecular Assay (A57606)
81551
L37675 MolDX: Corus® CAD Assay
  • Billing and Coding: MolDX: Corus® CAD Assay (A57416)
81493
L37618 MolDX: Cystatin C Measurement
  • Billing and Coding: MolDX: Cystatin C Measurement (A57644)
82610
L37748 MolDX: DecisionDx-Melanoma
  • Billing and Coding: MolDX: DecisionDX-Melanoma (A57418)
81599
L37072 MolDX: DecisionDx-UM (Uveal Melanoma)
  • Billing and Coding: MolDX: DecisionDX-UM (Uveal Melanoma) (A57622)
81552
L37311 MolDX: EndoPredict® Breast Cancer Gene Expression Test
  • Billing and Coding: MolDX: EndoPredict® Breast Cancer Gene Expression Test (A57608)
81599
L37891 MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
  • Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test (A57420)
81479
L36186 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
  • Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease (A57422)
  • Billing and Coding: MolDX: BCR-ABL (A55600)
81206, 81207, 81208, 81219, 81270, 81402, 81403, 81445, 81450, 81455, 81479, 0040U
L36374 MolDX: Genetic Testing for Lynch Syndrome
  • Billing and Coding: MolDX: Genetic Testing for Lynch Syndrome (A54996)
  • Billing and Coding: MolDX: Microsatellite Instability-High (MSI-H) and Mismatch Repair Deficient (dMMR) Biomarker Billing and Coding Guidelines for Patients with Unresectable or Metastatic Sold Tumors (A56104)
81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433, 81445, 81455, 81479, 0102U, 0103U, 0129U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U
L36368 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
  • Billing and Coding: MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay (A57464)
0047U
L36149 MolDX: HLA-B*15:02 Genetic Testing
  • Billing and Coding: MolDX: HLA-B*15:02 Genetic Testing (A57468)
81381
L36544 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
  • Billing and Coding: HLA-DQB1*06:02 Testing for Narcolepsy (A57465)
81383
L37899 MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer
  • Billing and Coding: MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer (A57665)
81479
L37622 MolDX: MDS FISH
  • Billing and Coding: MolDX: MDS FISH (A57662)
88271, 88273, 88274, 88275, 88291
L36192 MolDX: MGMT Promoter Methylation Analysis
  • Billing and Coding: MolDX: MGMT Promoter Methylation Analysis (A57433)
81287
L36256 MolDX: Molecular Diagnostic Tests (MDT)
  • Billing and Coding: MolDX: Abbott RealTime IDH2 testing for Acute Myeloid Leukemia (AML) (A55712)
  • Billing and Coding: MolDX: Afirma™ Assay by Veracyte (A54358)
  • Billing and Coding: MolDX: AlloMap (A54366)
  • Billing and Coding: MolDX: Avise PG Assay (A54378)
  • Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® (A54388)
  • Billing and Coding: MolDX: FDA-Approved BRAF Tests (A54420)
  • Billing and Coding: MolDX: FDA-Approved EGFR Tests (A54424)
  • Billing and Coding: MolDX: FDA-Approved KRAS Tests (A54500)
  • Billing and Coding: MolDX: HERmark Assay by Monogram (A54439)
  • Billing and Coding: MolDX: MammaPrint (A54447)
  • Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT) (A57527)
  • Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay (A54482)
  • Billing and Coding: MolDX: Oncotype DX® Colon Cancer (A54486)
  • Billing and Coding: MolDX: Progensa® PCA3 Assay (A54492)
  • Billing and Coding: MolDX: ResponseDX Tissue of Origin® (A54496)
  • Billing and Coding: MolDX: ThermoFisher Oncomine Dx Target Test For Non-Small Cell Lung Cancer (A55888)
  • Billing and Coding: MolDX: Vectra™ DA (A54505)
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
L36171  
  • Billing and Coding: MolDX: Molecular RBC Phenotyping (A57445)
0001U
L37315 MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels
  • Billing and Coding: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels (A57340)
87631, 87632, 87633, 0098U, 0099U, 0100U, 0115U
L37881 MolDX: myPath Melanoma Assay
  • Billing and Coding: MolDX: myPath Melanoma Assay (A57627)
81479, 0090U
L36339 MolDX: NRAS Genetic Testing
  • Billing and Coding: MolDX: NRAS Genetic Testing (A57487)
81311, 81479
L37744 MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)
  • Billing and Coding: MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate cancer (MCRPC) (A57499)
81479
L36947 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
  • Billing and Coding: MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ (A57620)
0045U
L37321 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer
  • Billing and Coding: MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay (A57464)
0047U
L36891 MolDX: Percepta© Bronchial Genomic Classifier
  • Billing and Coding: MolDX: Percepta© Bronchial Genomic Classifier (A57504)
81479
L38337 MolDX: Pharmacogenomics Testing
  • Billing and Coding: MolDX: Pharmacogenomics Testing (A57385)
81220, 81225, 81226, 81227, 81231, 81232, 81283, 81306, 81335, 81350, 81355, 81371, 81373, 81379, 81406, 0030U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U
L38329 MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer
  • Billing and Coding: MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer (A58272)
81479
L36350 MolDX: Prolaris™ Prostate Cancer Genomic Assay
  • Billing and Coding: MolDX: Prolaris™ Cancer Genomic Assay (A57511)
81541
L37082 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
  • Billing and Coding: MolDX: Prolaris™ Prostate  Cancer Genomic Assay for Men with Favorable Intermediate risk Disease (A57691)
81479
L36706 MolDX: ProMark Risk Score
  • Billing and Coding: MolDX: ProMark Risk Score (A57609)
81479
L38137 MolDX: TruGraf Blood Gene Expression Test
  • Billing and Coding: MolDX: TruGraf Blood Gene Expression Test (A57747)
81479

 

Non LCD Related Articles

Article Number MolDX Title CPT/HCPCS Codes Referenced
A56323 Billing and Coding: MolDX: Clonoseq® Assay for Assessment of Minimal Residual Disease (MRD) in Patients with Specific Lymphoid Malignancies 81479
A56013 Billing and Coding: MolDX: FDA Approved CLL Companion Diagnostic Test 82271, 82275, 88291, 88374, 88377
A55278 Billing and Coding: MolDX: L1CAM Gene Sequencing 81407
A55591 Billing and Coding: MolDX: Mitochondrial Nuclear Gene Tests 81479
A55615 Billing and Coding: MolDX: NSD1 Gene Tests 81403, 81405, 81406, 81479
A55614 Billing and Coding: MolDX: RPS19 Gene Tests 81403, 81405, 81479
A56518 Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer 81445, 81450, 81479
A58121 Billing and Coding: MolDX: Testing of Multiple Genes 81120, 81121, 81161, 81162, 81163, 81164, 81165, 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, 81236, 81237, 81238, 81239, 81240, 81241, 81242, 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, 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, 81340, 81341, 81342, 81343, 81344, 813445, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81445, 81448, 81450
A55275 MolDX: Know Error Update 84999
A56104 MolDX: Microsatellite Instability-High (MSI-H) and Mismatch Repair Deficient (dMMR) Biomarker Billing and Coding Guidelines for Patients with Unresectable or Metastatic Solid Tumors 81301, 81479, 88341, 88342
A55293 MolDX: myPap Billing and Coding Guidelines 84999
A55598 MolDX: OncoCee Billing and Coding Guidelines 86152, 86153

 

Last Updated Tue, 21 Sep 2021 14:39:18 +0000