Traditional MedicareCoverageMedium impact
MolDX: Genetic Testing for Hereditary Thrombophilia
Medicare/CMS - LCD·Hematology, Genetics, Internal Medicine·Local Coverage Determination
Effective date
Oct 12, 2026
We identified it
Aug 27, 2026
Summary
Noridian Healthcare Solutions (MAC Part A/B) has issued a new Local Coverage Determination (LCD L40242) effective 10/12/2026 establishing coverage policies for genetic testing of hereditary thrombophilia. This policy will govern which thrombophilia genetic tests are covered, under what clinical circumstances, and what documentation is required for Medicare claims in the Noridian service area.
Action Required
Before 10/12/2026: Billing and clinical teams must obtain and review the full LCD L40242 policy text from the CMS coverage database (https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=40242&ver=3) to identify specific CPT/HCPCS codes, covered indications, and documentation requirements. Update billing system rules, prior authorization protocols, and provider education materials to align with covered services and medical necessity criteria. Coordinate with providers and lab partners to ensure compliance with any new ordering or documentation requirements. Failure to follow the LCD requirements will result in claim denials for non-compliant testing orders.