CodeMap® LCD-L39040

Contractor Information

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

Contractor Number: 05401
Contractor Type: MAC A

LCD Information

LCD ID Number: L39040 Status: A-Approved
LCD Title: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer
Geographic Jurisdiction: Nebraska Other Jurisdictions
Original Determination Effective Date: 07/03/2022
Original Determination Ending Date:
Revision Effective Date: 04/18/2024
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(a) 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

National Coverage Determination (NCD) 90.2, which allows contractors to cover next generation sequencing tests as a diagnostic laboratory test for patients with cancer in specific circumstances

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01/23/2025 08:32:50 18.97.9.175

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