Traditional MedicareCoverageMedium impact
MolDX: Molecular Testing for Solid Organ Allograft Rejection
Medicare/CMS - LCD·Transplant Surgery, Pathology, Internal Medicine·Local Coverage Determination
Effective date
Aug 30, 2026
We identified it
Jul 16, 2026
Summary
This is a NEW local coverage determination (LCD L40062) from Noridian Healthcare Solutions establishing Medicare coverage criteria for molecular testing (MolDX) to detect solid organ allograft rejection. The policy becomes effective 8/30/2026 and applies to Part A and Part B Medicare claims in Noridian's service area. Billing teams must understand covered indications, prior authorization requirements, and any specific molecular test codes to ensure proper claim submission and reimbursement.
Action Required
By August 29, 2026: (1) Billing team must obtain and review the full LCD L40062 policy text from the CMS Medicare Coverage Database link provided to identify specific CPT/HCPCS codes covered for molecular testing in allograft rejection; (2) Determine if prior authorization is required by Noridian and establish internal prior auth workflow if needed; (3) Update billing system and encounter documentation templates to capture required medical necessity criteria for allograft rejection testing; (4) Notify transplant surgery and relevant clinical providers of coverage requirements and documentation expectations; (5) Contact Noridian directly at their contractor line if specific billing codes are not clear in the policy. Failure to comply may result in claim denials or delayed reimbursement for molecular allograft rejection testing starting 8/30/2026.