Traditional MedicareCoverageMedium impact
MolDX: Genetic Testing for Hereditary Thrombophilia
Medicare/CMS - LCD·Genetics, Hematology, Internal Medicine·Local Coverage Determination
Effective date
Oct 12, 2026
We identified it
Aug 27, 2026
Summary
This is a new Local Coverage Determination (LCD L40238) from Palmetto GBA establishing coverage criteria for genetic testing of hereditary thrombophilia. The policy becomes effective October 12, 2026, and will define which thrombophilia genetic tests are covered under Medicare Part A and Part B in the Palmetto GBA jurisdiction. Billing teams must review the full policy text to identify specific covered tests, required documentation, and any prior authorization requirements.
Action Required
By October 12, 2026: Billing team must obtain and review the complete policy text from the CMS Medicare Coverage Database (URL provided). Identify all CPT and HCPCS codes covered for hereditary thrombophilia genetic testing. Determine if prior authorization is required and update billing system rules accordingly. Notify providers and front-desk staff of coverage requirements. Update encounter forms or billing templates to capture required clinical documentation (e.g., family history, clinical indicators for testing). Train coding staff on correct code selection per LCD criteria. After implementation, validate that all thrombophilia genetic test claims include appropriate documentation and coding per this LCD to prevent denials.