Medicare local coverage
Medicare coverage for MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) (LCD)
4 Medicare Administrative Contractors publish a local coverage determination (LCD) for MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™). 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 | L36951 | Active | Sep 26, 2025 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L36947 | Retired Feb 5, 2026 | Feb 5, 2026 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L36941 | Active | Jan 26, 2026 |
Palmetto GBAMAC - Part A, MAC - Part B | L36912 | Active | Dec 1, 2021 |
WPS Insurance CorporationMAC - Part A, MAC - Part B | L37199 | Active | Oct 21, 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.
- A56870Palmetto GBAUpdated Nov 16, 2021
- A56887CGS Administrators, LLCUpdated Nov 15, 2023
- A57583WPS Insurance CorporationUpdated Oct 22, 2025
- A57619Noridian Healthcare Solutions, LLCUpdated Jan 26, 2026
- A57620Noridian Healthcare Solutions, LLCUpdated Feb 24, 2026
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 Assay: Prosigna®
- MolDX: Breast Cancer Index® (BCI) Gene Expression Test
- MolDX: EndoPredict Breast Cancer Gene Expression Test
- 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.