150 North Wacker Drive
Suite 2360
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax

User Information

Create New Account

Lost Password


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule


Physician Fee Schedule


OPPS Fee Schedule


ASC Fee Schedule


APC Codes


DRG Codes


ASP Drug Pricing Files

January 2024
October 2023

CMS Transmittals

CodeMap® LCD-L38968


Printer Friendly Version

LCD for Thyroid Nodule Molecular Testing (L38968)
See related Articles:
A58656-Billing and Coding: Thyroid Nodule Molecular Testing
A58853-Response to Comments: Thyroid Nodule Molecular Testing

Contractor Information

Contractor Name: National Government Services, Inc. - Full list of policies of this Medicare Contractor

Contractor Number: 14211

Contractor Type: MAC A

LCD Information

LCD ID Number: L38968 Status: A-Approved

LCD Title: Thyroid Nodule Molecular Testing

Geographic Jurisdiction: Massachusetts Other Jurisdictions

Original Determination Effective Date: 12/01/2021

Original Determination Ending Date:

Revision Effective Date:

Revision End Date:

CMS National Coverage Policy:

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):
Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Section 1862(a)(7) excludes routine physical examinations, unless otherwise covered by statute.

CMS Publications:
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 80.1 – Laboratory services must meet applicable requirements of CLIA

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 16, Section 40.7 Billing for Noncovered

Clinical Laboratory Tests Section and 120.1 Clarification of the Use of the Term “Screening” or “Screen”

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, Section 50 Advance Beneficiary Notice of Noncoverage (ABN)

CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Local Coverage Determinations

CMS National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services, Chapter 10, Pathology/Laboratory Services, (A) Introduction

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 80.6. 5 which describes the Surgical/Cytopathology Exception.

CMS National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services, Chapter 10 Pathology/Laboratory Services which addresses reflex testing.

CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 3, Section 190.3 Cytogenetic Studies.

Code of Federal Regulations:
42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).


Sorry, you need to login or register to view additional sections of this Medicare policy.


All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.

03/04/2024 06:57:27

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.