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
This is a new Local Coverage Determination (LCD L40259) from CGS Administrators establishing coverage policies for genetic testing for hereditary thrombophilia. The policy becomes effective October 12, 2026, and will define which genetic thrombophilia tests are covered, under what clinical circumstances, and any prior authorization requirements for Medicare beneficiaries in CGS service areas.
Action Required
By October 11, 2026: Billing team must obtain and review the complete LCD L40259 policy text from the CMS Medicare Coverage Database (https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=40259&ver=4) to identify specific CPT and HCPCS codes covered for hereditary thrombophilia genetic testing. Once codes are identified, update billing software to implement any prior authorization requirements and coverage restrictions. Providers must be notified of coverage criteria. Ensure all claims submitted on or after October 12, 2026 comply with the new policy to avoid denials.