Traditional MedicareCoverageMedium impact
MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis
Medicare/CMS - LCD·Gastroenterology, Internal Medicine, Pathology·Local Coverage Determination
Effective date
Aug 10, 2026
We identified it
Jun 25, 2026
Summary
WPS Insurance Corporation (Medicare MAC Part A/B) is implementing a new Local Coverage Determination (L40272) effective August 10, 2026, establishing coverage policies and requirements for biomarker testing in metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). Billing teams must review the full policy text to identify covered tests, medical necessity criteria, and any prior authorization requirements before the effective date.
Action Required
By August 9, 2026: Obtain and review the complete LCD L40272 policy text from the CMS Medicare Coverage Database (https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=40272&ver=3). Identify all specific CPT and HCPCS codes for biomarker tests covered under MASLD/MASH criteria. Billing team must: (1) Update billing system to apply correct coding and medical necessity edits for these tests; (2) Implement any prior authorization requirements specified in the policy; (3) Train providers on documentation requirements for medical necessity; (4) Update claim submission templates and encounter forms to capture required clinical information. Failure to comply with coverage and medical necessity requirements will result in claim denials for non-compliant submissions.