September 30, 2015 - Updated 05.11.21
MolDX LCDs
ID |
Title / ID |
Effective Date |
Revision Effective Date |
Last Updated |
Status |
HCPC/CPT Code |
Related Policy Article(s) |
---|---|---|---|---|---|---|---|
MolDX: 4Kscore Assay |
3/13/17 |
4/1/21 |
3/26/21 |
Active |
81539 |
||
MolDX: AlloSure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts |
12/28/20 |
NA |
11/4/20 |
Active |
Group 1 81479 |
||
MolDX: Androgen Receptor Variant (AR-V7) Protein Test |
3/25/19 |
5/9/21 |
3/19/21 |
Future |
81479 |
A57158 – Billing and Coding: MolDX: Androgen Receptor Variant (AR-V7) Protein Test |
|
MolDX: APC and MUTYH Gene Testing |
3/13/17 |
4/1/21 |
3/26/21 |
Active |
Group 1: 81201, 81202, 81203, 81479 |
||
MolDX: BDX-XL2 |
7/10/17 |
11/19/20 |
11/16/20 |
Active |
0080U |
||
MolDX: Blood Product Molecular Antigen Typing |
11/1/20 |
12/10/20 |
12/1/20 |
Active |
Group 1 21403, 0001U, 0084U |
A57155 – Billing and Coding: MolDX: Blood Product Molecular Antigen Typing |
|
MolDX: Biomarkers in Cardiovascular Risk Assessment |
10/5/15 |
11/14/19 |
6/19/20 |
Active |
81439, 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141 |
A54685 – Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy (ARVD / C) Testing Coding and Billing Guidelines |
|
MolDX: BRCA1 and BRCA2 Genetic Testing |
2/15/16 |
4/29/21 |
4/21/21 |
Active |
Group 1: 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, 81433, 81479, 0102U, 0103U, 0129U |
A56971 – Billing and Coding: MolDX: BRCA1 and BRCA2 Genetic Testing |
|
MolDX: Breast Cancer Assay: Prosigna |
2/1/16 |
9/23/19 |
8/25/20 |
Active |
81520 |
A56989 – Billing and Coding: MolDX: Breast Cancer Assay: Prosigna |
|
MolDX: Breast Cancer™ (BCI) Gene Expression Test |
4/1/19 |
5/2/21 |
3/22/21 |
Future |
81518 |
A56884 – Billing and Coding: MolDX: Breast Cancer Index™ (BCI) Gene Expression Test |
|
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay |
10/5/15 |
4/22/21 |
4/16/21 |
Active |
81551 |
A57031 – Billing and Coding: MolDX: ConfirmMDx Epigenetic Molecular Assay |
|
MolDX - CDD: ProMark Risk Score |
10/10/16 |
11/28/19 |
10/21/20 |
Active |
81479 |
A57034 – Billing and Coding: MolDX – CDD: ProMark Risk Score |
|
MolDX: Circulating Tumor Cell Marker Assays |
3/6/17 |
5/6/21 |
4/29/21 |
Active |
86152, 86153 |
A57288 – Billing and Coding: MolDX: Circulating Tumor Cell Marker Assays |
|
MolDX: Corus® CAD Assay |
11/12/18 |
9/19/19 |
11/16/20 |
Active |
81493 |
||
MolDX: Cystatin C Measurement |
12/17/18 |
12/10/20 |
12/1/20 |
Active |
82610 |
||
MolDX: Melanoma Risk Stratification Molecular Testing |
6/24/19 |
12/21/20 |
10/26/20 |
Active |
81529, 81599 |
A57165 – Billing and Coding: MolDX: Melanoma Risk Stratification Molecular Testing |
|
MolDX: DecisionDx-UM (Uveal Melanoma) |
7/10/17 |
10/31/19 |
5/27/20 |
Active |
81552 |
A56981 – Billing and Coding: MolDX: DecisionDx-UM (Uveal Melanoma) |
|
MolDX: EndoPredict Breast Cancer Gene Expression Test |
3/6/18 |
11/14/19 |
11/8/19 |
Active |
81522 |
A56997 – Billing and Coding: MolDX: EndoPredict Breast Cancer Gene Expression Test |
|
MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test |
5/20/19 |
11/7/19 |
2/28/20 |
Active |
81479 |
A56985 – Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test |
|
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease |
10/5/15 |
12/19/19 |
6/30/20 |
Active |
Group 1: 81206, 81207, 81208, 81219, 81270, 81402, 81479, 0040U |
A54686 – Billing and Coding: MolDX: BCR-ABL |
|
MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) |
10/1/15 |
10/31/15 |
6/30/20 |
Active |
81240, 81241, 81291 |
||
MolDX: Genetic Testing for Lynch Syndrome |
10/1/15 |
12/5/19 |
11/16/20 |
Active |
Group 1: 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81317, 81318, 81319, 81479, 88341,88342, 0101U |
A56882 – Billing and Coding: MolDX: Genetic Testing for Lynch Syndrome |
|
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy |
2/15/16 |
12/24/20 |
12/18/20 |
Active |
81383 |
A56881 – Billing and Coding: MolDX: HLA-DQB1*06:02 Testing for Narcolepsy |
|
MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer |
5/13/19 |
3/5/20 |
3/25/20 |
Active |
81479 |
||
MolDX: MDS FISH |
5/6/19 |
11/7/19 |
3/25/20 |
Active |
88271, 88273, 88274, 88275, 88291 |
||
MolDX: MGMT Promoter Methylation Analysis |
10/5/15 |
6/4/20 |
5/26/20 |
Active |
81287 |
A56983 – Billing and Coding: MolDX: MGMT Promoter Methylation Analysis |
|
MolDX: Minimal Residual Disease Testing for Colorectal Cancer |
10/19/20 |
NA |
8/26/20 |
Active |
81479 |
A58330 - Billing and Coding: MolDX: Minimal Residual Disease Testing for Colorectal Cancer |
|
MolDX: Molecular Testing for Solid Organ Allograft Rejection |
6/6/21 |
NA |
NA |
Future |
81479, 81595, 81599 |
A58061 – Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection |
|
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels |
12/3/18 |
11/30/20 |
12/14/20 |
Active |
Group 1: 87631, 87636, 87637, 0240U, 0241U |
||
MolDX: myPath Melanoma Assay |
6/3/19 |
10/31/19 |
3/25/20 |
Active |
81479, 0090U |
||
MolDX: Next-Generation Sequencing for Solid Tumors |
2/10/20 |
3/5/20 |
3/12/20 |
Active |
81445, 81479 |
A57870 – Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors |
|
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies |
2/10/20 |
3/5/20 |
3/12/20 |
Active |
81450, 81479 |
||
MolDX: NRAS Genetic Testing |
10/1/15 |
11/28/19 |
1130/20 |
Active |
81311, 81479 |
||
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health®) |
3/6/17 |
11/28/19 |
11/21/20 |
Active |
0045U |
A56887 – Billing and Coding: MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) |
|
MolDX: Percepta® Bronchial Genomic Classifier |
3/13/17 |
11/28/19 |
11/30/20 |
Active |
81479 |
A56972 – Billing and Coding: MolDX: Percepta® Bronchial Genomic Classifier |
|
MolDX: Pharmacogenomics Testing |
8/3/20 |
8/3/20 |
6/12/20 |
Active |
81220, 81225, 81226, 81227, 81231, 81232, 81247, 81283, 81306, 81328, 81335, 81350, 81355, 81374, 81377, 81381, 81383, 81406, 0030U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U |
A58324 - Billing and Coding: MolDX: Pharmacogenomics Testing |
|
MolDX: Pigmented Lesion Assay |
3/30/20 |
NA |
2/5/20 |
Active |
0089U |
||
MolDX: Plasma-Based Genomic Profiling in Solid Tumors |
7/27/20 |
NA |
6/4/20 |
Active |
81445, 81479 |
A57917 - Billing and Coding: MolDX: Plasma-Based Genomic Profiling in Solid Tumors |
|
MolDX: Predictive Classifiers for Early Stage Non-small Cell Lung Cancer |
7/27/20 |
NA |
6/4/20 |
Active |
81479 |
||
MolDX: Prolaris® Prostate Cancer Genomic Assay |
10/5/15 |
11/7/19 |
7/13/20 |
Active |
81541 |
A57303 – Billing and Coding: MolDX: Prolaris™ Prostate Cancer Genomic Assay |
|
MolDX: Prolaris® Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease |
7/10/17 |
6/4/20 |
5/26/20 |
Active |
81541 |
||
MolDX: Prometheus IBD sgi Diagnostic Policy |
11/6/17 |
2/25/21 |
2/25/21 |
Active |
81479, 82397, 83520, 86140 |
A56940 – Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy |
|
MolDX: Prospera |
3/10/20 |
12/24/20 |
12/18/20 |
Active |
81479 |
||
MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease |
11/9/20 |
NA |
9/14/20 |
Active |
81541, 81542, 0047U |
||
MolDX: Repeat Germline Testing |
6/7/20 |
NA |
4/17/20 |
Active |
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, 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, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81302, 81303, 81304, 81306, 81312, 81317, 81318, 81319, 81321, 81322, 81323, 81324, 81325, 81326, 81328, 81329, 81330, 81331, 81332, 81333, 81335, 81336, 81337, 81340, 81341, 81342, 81343, 81344, 81345, 81346, 81350, 81355, 81361, 81362, 81363, 81364, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81448, 81460, 81465, 81470, 81471 |
||
MolDX: TruGraf Blood Gene Expression Test |
12/30/19 |
12/24/20 |
12/18/20 |
Active |
81479 |
A57446 – Billing and Coding: MolDX: TruGraf Blood Gene Expression Test |
|
Molecular Diagnostic Tests (MDT) |
10/1/15 |
12/19/19 |
11/30/20 |
Active |
Group 1: 81105, 81106, 81107 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161 - 81364 81400, 81402, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81413 - 81595 81599, 84999, 85999, 86152, 86153, 86849, 87999, 88341, 88342, 88360, 88361, 0004M, 0006M, 0007M, 0011M, 0012M, 0013M, 0001U, 0003U, 0005U, 0009U, 0012U, 0013U, 0014U, 0016U, 0017U, 0018U, 0019U, 0021U, 0022U, 0023U, 0024U, 0026U, 0027U, 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0036U, 0037U, 0039U, 0040U, 0045U – 0050U 0053U – 0060U 0062U, 0067U, 0068U, 0070U – 0076U, 0078U – 0080U 0083U, 0084U, 0087U – 0092U 0094U, 0101U – 0103U 0105U, 0107U, 0108U, 0111U, 0113U, 0114U, 0118U, 0120U, 0129U – 0132U, 0134U – 0138U, 0153U - 0162U |
Click to expand the full list of related policy articles A55716 – Billing and Coding: MolDX: Abbott RealTime IDH1 and IDH2 testing for Acute Myeloid Leukemia (AML) |