Medicare local coverage
Medicare coverage for MolDX: Breast Cancer Assay: Prosigna® (LCD)
4 Medicare Administrative Contractors publish a local coverage determination (LCD) for MolDX: Breast Cancer Assay: Prosigna®. The snapshot lists 5 LCD records: 4 active, 1 retired.
An LCD applies only in the jurisdiction of the contractor that wrote it. Two contractors can cover the same service with different criteria, documentation requirements and covered diagnoses, so check the LCD from the contractor that processes your claims.
LCDs by contractor
| Contractor | LCD | Status | Last updated |
|---|---|---|---|
CGS Administrators, LLCMAC - Part A, MAC - Part B | L36425 | Active | Mar 9, 2026 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L36386 | Retired Jan 22, 2026 | Jan 22, 2026 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L36380 | Active | Jan 12, 2026 |
Palmetto GBAMAC - Part A, MAC - Part B | L36125 | Active | Apr 15, 2021 |
WPS Insurance CorporationMAC - Part A, MAC - Part B | L36811 | Active | Apr 22, 2025 |
An LCD marked Future has been finalized and is in its notice period; it applies from the effective date shown. LCD IDs link to the record on cms.gov.
Billing and coding articles
The codes live in the billing and coding article that goes with each LCD: the CPT and HCPCS codes the policy applies to, the ICD-10 codes that support medical necessity, and any modifier or documentation rules.
- A56949Palmetto GBAUpdated Apr 15, 2021
- A56989CGS Administrators, LLCUpdated Nov 8, 2023
- A57363Noridian Healthcare Solutions, LLCUpdated Jan 12, 2026
- A57364Noridian Healthcare Solutions, LLCUpdated Jan 22, 2026
- A57560WPS Insurance CorporationUpdated Apr 25, 2025
CMS also lists 1 response-to-comments article for this topic, where contractors answer public comments on the proposed LCD: A54790.
Check claim lines against Medicare coverage
Coverage Check tells you whether a claim's diagnoses support Medicare LCD or NCD coverage for each procedure line, and shows the policy and CMS source behind each answer.
Related LCD topics
- MolDX: Breast Cancer Index® (BCI) Gene Expression Test
- MolDX: EndoPredict Breast Cancer Gene Expression Test
- MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
- MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease
- Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
- Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
All Medicare LCD topics · National coverage determinations · Payer policies by payer
Source: CMS Medicare Coverage Database, via the public CMS Coverage API, snapshot Oct 25, 2026. LCDs change between snapshots; confirm the version in effect for your date of service on cms.gov before billing.