Traditional MedicareCoverageMedium impact
MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer
Medicare/CMS - LCD·Oncology, Hematology·Local Coverage Determination
Effective date
Apr 18, 2024
We identified it
Jun 17, 2026
Summary
This Local Coverage Determination establishes coverage criteria for lab-developed tests used to identify inherited cancer syndromes in patients who already have cancer. The policy provides specific guidelines for when these genetic tests will be covered by Medicare.
Action Required
By April 18, 2024: Billing team must review coverage criteria for inherited cancer syndrome testing in cancer patients. Ensure documentation meets Medicare requirements before submitting claims for lab-developed genetic tests. Verify patient eligibility and medical necessity documentation is complete to avoid claim denials.