Medicare local coverage
Medicare coverage for MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer (LCD)
4 Medicare Administrative Contractors publish a local coverage determination (LCD) for MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer. 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 | L38997 | Active | Mar 10, 2026 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L39007 | Retired Jan 22, 2026 | Jan 22, 2026 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L39005 | Active | Jan 12, 2026 |
Palmetto GBAMAC - Part A, MAC - Part B | L38985 | Active | Jun 25, 2025 |
WPS Insurance CorporationMAC - Part A, MAC - Part B | L39042 | Active | Jun 17, 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.
- A58700Palmetto GBAUpdated Jun 16, 2026
- A58713CGS Administrators, LLCUpdated Jun 19, 2026
- A58718Noridian Healthcare Solutions, LLCUpdated Jun 16, 2026
- A58724Noridian Healthcare Solutions, LLCUpdated Jan 22, 2026
- A58759WPS Insurance CorporationUpdated Jun 17, 2026
CMS also lists 5 response-to-comments articles for this topic, where contractors answer public comments on the proposed LCD: A59069, A59112, A59118, A59142, A59144.
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: Molecular Biomarkers for Risk Stratification of Indeterminate Pulmonary Nodules Following Bronchoscopy
- MolDX: Biomarkers in Cardiovascular Risk Assessment
- MolDX: Inivata™, InvisionFirst®, Liquid Biopsy for Patients with Lung Cancer
- MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer
- MolDX: Melanoma Risk Stratification Molecular Testing
- MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneous Squamous Cell Carcinoma
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.