Traditional MedicareCoverageMedium impact
MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
Medicare/CMS - LCD·Oncology, Urology, Pathology·Local Coverage Determination
Effective date
May 21, 2026
We identified it
Jun 17, 2026
Summary
This is a new Local Coverage Determination (LCD) for molecular classifiers used in bladder cancer diagnosis and prognosis, effective May 21, 2026. The policy establishes coverage criteria and billing guidelines for prognostic and predictive molecular testing in bladder cancer patients under Medicare.
Action Required
By May 21, 2026: Billing team must review the full LCD L38586 policy text to identify specific CPT/HCPCS codes and coverage requirements for bladder cancer molecular testing. Providers treating bladder cancer patients should update documentation requirements and prior authorization processes per the new LCD guidelines. Claims for molecular classifiers submitted without meeting LCD criteria will be denied.