Traditional MedicareCoverageHigh impact
MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Targeted Therapy in Cancer
Medicare/CMS - LCD·Oncology, Pathology·Local Coverage Determination
Effective date
Oct 12, 2026
We identified it
Aug 27, 2026
Summary
This is a NEW Local Coverage Determination (LCD L40210) from Palmetto GBA effective October 12, 2026, establishing coverage policies for non-Next Generation Sequencing (non-NGS) targeted molecular panel tests used for targeted cancer therapy decisions. The policy defines which molecular tests are covered under Medicare Part A and Part B for cancer patients. Billing teams must review the specific test codes and coverage criteria in the full policy to ensure compliant billing starting 10/12/2026.
Action Required
By October 12, 2026: Billing team must obtain and review the complete policy text at https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=40210&ver=5 to identify specific CPT/HCPCS codes for non-NGS molecular panel tests covered under this LCD. Update billing system with coverage rules, medical necessity requirements, and any prior authorization thresholds. Provider education team should communicate coverage criteria to oncology physicians. Claims submitted after 10/12/2026 for molecular panel tests must align with this new LCD or face denial. Implement verification in billing software to confirm test type (non-NGS vs NGS) and medical necessity documentation before claim submission. Monitor claim denials related to molecular testing and adjust workflows as needed.