Medicare local coverage
Medicare coverage for MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia (LCD)
4 Medicare Administrative Contractors publish a local coverage determination (LCD) for MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia. 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 | L39276 | Active | Feb 13, 2026 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L39264 | Retired Jan 22, 2026 | Jan 22, 2026 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L39262 | Active | Jan 12, 2026 |
Palmetto GBAMAC - Part A, MAC - Part B | L39256 | Active | Mar 4, 2025 |
WPS Insurance CorporationMAC - Part A, MAC - Part B | L39356 | Active | Feb 20, 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.
- A59015Palmetto GBAUpdated Mar 24, 2023
- A59032Noridian Healthcare Solutions, LLCUpdated Jan 12, 2026
- A59034Noridian Healthcare Solutions, LLCUpdated Jan 22, 2026
- A59051CGS Administrators, LLCUpdated Feb 6, 2025
- A59121WPS Insurance CorporationUpdated Mar 22, 2023
CMS also lists 5 response-to-comments articles for this topic, where contractors answer public comments on the proposed LCD: A59343, A59344, A59353, A59354, A59360.
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
- Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
- Upper Gastrointestinal Endoscopy and Visualization
- Automated Detection and Quantification of Brain MRIs
- Cardiac Event Detection
- Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities
- External Upper Limb Tremor Stimulator Therapy
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.