CodeMap® LCD-L38835

Contractor Information

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

Contractor Number: 05302
Contractor Type: MAC B

LCD Information

LCD ID Number: L38835 Status: A-Approved
LCD Title: MolDX: Minimal Residual Disease Testing for Cancer
Geographic Jurisdiction: Missouri - Entire State, Missouri - Northwestern Other Jurisdictions
Original Determination Effective Date: 12/26/2021
Original Determination Ending Date:
Revision Effective Date: 10/26/2023
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act, §1862(a)(1)(A). Allows coverage and payment for only those services that are considered to be reasonable and necessary.

42 Code of Federal Regulations (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, §80.0, 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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06/25/2025 03:23:42 18.97.14.90

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