Medicare local coverage
Medicare coverage for Molecular Pathology Procedures (LCD)
2 Medicare Administrative Contractors publish a local coverage determination (LCD) for Molecular Pathology Procedures. The snapshot lists 2 LCD records: 2 active.
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 |
|---|---|---|---|
First Coast Service Options, Inc.MAC - Part A, MAC - Part B | L34519 | Active | Dec 3, 2021 |
Wellpoint FederalMAC - Part A, MAC - Part B | L35000 | Active | Jul 16, 2026 |
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.
- A56199Wellpoint FederalUpdated Jul 16, 2026
- A57451First Coast Service Options, Inc.Updated Jan 19, 2024
CMS also lists 6 response-to-comments articles for this topic, where contractors answer public comments on the proposed LCD: A55334, A55982, A59383, A59767, A59968, A60451.
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
- Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow
- Home Health Speech-Language Pathology
- MolDX: Blood Product Molecular Antigen Typing
- MolDX: Melanoma Risk Stratification Molecular Testing
- MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma
- 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.