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 L40222) from Noridian Healthcare Solutions establishing coverage policies for non-NGS targeted molecular panel tests used for targeted cancer therapy. The policy becomes effective October 12, 2026, and will define which molecular panel tests are covered, requirements for medical necessity documentation, and billing/coding guidelines for oncology practices.
Action Required
By October 11, 2026: Billing team and oncology providers must review the full LCD L40222 policy text at the provided CMS link to identify: (1) specific CPT/HCPCS codes assigned to covered non-NGS molecular panel tests, (2) medical necessity requirements and documentation standards, (3) any prior authorization requirements, and (4) coverage limitations or exclusions. Update billing software, encounter templates, and prior auth protocols accordingly. Clinical staff must ensure all molecular panel test orders include required documentation to support medical necessity. Failure to comply with coverage criteria will result in claim denials. ACTION DEFERRED PENDING POLICY DETAILS: The policy text summary provided does not include specific billing codes, documentation requirements, or coverage criteria—only the title and effective date. Obtain the complete policy document from https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=40222&ver=3 to extract actionable billing and clinical requirements.