Traditional MedicareCoverageMedium impact
MolDX: Molecular Testing for Solid Organ Allograft Rejection
Medicare/CMS - LCD·Transplant Surgery, Nephrology, Cardiothoracic Surgery·Local Coverage Determination
Effective date
Aug 30, 2026
We identified it
Jul 16, 2026
Summary
CGS Administrators, LLC (Medicare MAC for Part A and Part B) has issued a new Local Coverage Determination (LCD L40140) effective August 30, 2026, establishing coverage criteria for molecular testing (MolDX) to detect solid organ allograft rejection. This policy defines which molecular testing procedures are covered, the clinical indications for coverage, and documentation requirements for transplant recipients. Billing teams must verify test appropriateness against these criteria before submission to avoid denials.
Action Required
By August 30, 2026: Billing team must obtain and review the full policy text from the CMS coverage database (https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=40140&ver=6) to identify specific HCPCS/CPT codes and coverage criteria for molecular allograft rejection testing. Implement workflow to ensure: (1) providers document clinical indication for testing per policy requirements before ordering, (2) billing system flags these claims for review against LCD L40140 coverage criteria, and (3) staff verify patient is Medicare beneficiary within CGS MAC service area before processing claims. Update transplant and nephrology provider encounter templates with coverage requirements checklist. Without pre-claim verification, claims may be denied for medical necessity or coverage determination issues.