Traditional MedicareCoverageMedium impact
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
Medicare/CMS - LCD·Neurology, Sleep Medicine·Local Coverage Determination
Effective date
Jul 16, 2026
We identified it
Jul 16, 2026
Summary
CGS Administrators, LLC (MAC - Part A and Part B) has issued a new Local Coverage Determination (L36485) effective 7/16/2026 establishing coverage policy for HLA-DQB1*06:02 genetic testing used to support narcolepsy diagnosis. This policy defines medical necessity criteria, appropriate patient populations, and billing/coding requirements for this specialized immunogenetic test.
Action Required
By July 16, 2026: Billing team and providers must obtain and review the complete policy text from the CMS Medicare Coverage Database (LCD L36485, v23). Identify which billing codes are assigned to HLA-DQB1*06:02 testing in your practice's billing system and EHR. Verify that all narcolepsy-related HLA-DQB1*06:02 test orders include proper documentation of medical necessity per the new LCD requirements. Update any internal billing guidelines, prior authorization protocols, and encounter templates to reflect the new coverage determination. If your practice orders this test, confirm that all requisitions and claims submitted on or after 7/16/2026 comply with the LCD's medical necessity and documentation standards. Failure to follow this LCD may result in claim denials from CGS-administered Medicare plans.