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CodeMap® LCD-L38158


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LCD for MolDX: Next-Generation Sequencing for Solid Tumors (L38158)
See related Articles:
A55197-Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile Next Generation Sequencing Testing in Cancer
A57858-Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors
A57861-Response to Comments: Next-Generation Sequencing for Solid Tumor (DL38158)

Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor

Contractor Number: 05101

Contractor Type: MAC A

LCD Information

LCD ID Number: L38158 Status: A-Approved

LCD Title: MolDX: Next-Generation Sequencing for Solid Tumors

Geographic Jurisdiction: Iowa Other Jurisdictions

Original Determination Effective Date: 02/09/2020

Original Determination Ending Date:

Revision Effective Date: 06/08/2023

Revision End Date:

CMS National Coverage Policy:

Title XVIII of the Social Security Act (SSA), §1862(a)(1)(A), states that no Medicare payment shall be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”

42 CFR §410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests, §80.1.1 Certification Changes

CMS Internet-Only Manual, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1 Part 2, §90.2 Next-Generation Sequencing (NGS) for Patients with Advanced Cancer.

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09/29/2023 06:14:22

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