Traditional MedicareCoverageMedium impact
MolDX: MGMT Promoter Methylation Analysis
Medicare/CMS - LCD·Oncology, Neurology, Pathology·Local Coverage Determination
Effective date
Jul 9, 2026
We identified it
Jul 10, 2026
Summary
This is a new Local Coverage Determination (LCD L36113) from CGS Administrators for MolDX MGMT Promoter Methylation Analysis testing. The policy establishes coverage criteria, medical necessity requirements, and billing guidelines for MGMT promoter methylation testing effective July 9, 2026. Billing teams must obtain the complete policy details to identify specific CPT/HCPCS codes, prior authorization requirements, and documentation standards.
Action Required
By July 2, 2026 (before effective date): (1) Billing team must access the full policy text at https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=36113&ver=25 to identify specific billing codes, prior authorization requirements, and documentation standards for MGMT promoter methylation analysis testing. (2) Update billing system with any new codes or modifiers identified in the policy. (3) Determine if prior authorization is required and establish workflow for prior auth submission if applicable. (4) Brief laboratory and provider staff on new documentation requirements per the LCD. (5) Update claim submission processes to reflect coverage limitations or medical necessity criteria outlined in the full policy text. Without proper implementation, claims for MGMT testing submitted after 7/9/2026 may be denied by CGS Medicare Administrative Contractor (MAC Part A and Part B).