Noridian finalizes two MolDX coverage policies for California effective October 12 and retires the thrombophilia policy October 11
Aug 30, 2026 edition · GC-2026-0011 · Published 2026-08-30 · Version 2 · Final
Noridian’s August 27 notices finalize two MolDX policies for October 12 and retire the older thrombophilia policy October 11. Coverage remains conditional on each policy’s clinical and testing criteria; a test’s name alone does not establish coverage.
What happened
Noridian announced August 27 that two MolDX local coverage determinations for Jurisdiction E, including California, will take effect for services on or after October 12. L40242 addresses hereditary thrombophilia testing, with billing article A60272; L40222 addresses non-next-generation-sequencing targeted molecular panels used to guide cancer therapy, with article A60239. Noridian separately announced retirement of L36155, its hypercoagulability and thrombophilia policy covering Factor V Leiden, Factor II prothrombin and MTHFR, effective October 11. The retirement and new-policy dates need to be mapped to service dates, rather than assuming an order placed earlier automatically uses the former coverage basis.
The finalized hereditary-thrombophilia criteria require qualifying clinical circumstances, a result that guides management, appropriate validated genetic content and MolDX technical assessment, with limits on repeat testing. The non-NGS cancer-panel policy also requires all stated criteria: the result must inform treatment, the method must meet the specified feasibility or turnaround conditions, and validation and technical assessment requirements still apply. It expressly warns that reference to a test does not automatically imply coverage. Laboratory menus and medical-necessity checks therefore need the operative indications and associated coding articles, rather than only a replacement LCD number.
Scope and timing
- Authority status
- Final
- Applicability
- Directly applicable
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal, California, Hawaii, Nevada
- Affected functions
- Coding, Revenue Cycle, Clinical Operations, Compliance, Utilization Management, HIM/CDI
- Responsible owner
- Coding
- Recorded date
- 2026-10-12
- Date type
- effective
Why it matters
The effective and retirement dates create a defined transition for the coverage rules applied to services. Orders, laboratory information and billing screens should support the appropriate service-date policy and its clinical conditions, rather than treating finalization as unrestricted coverage.
Recommended action
Review L40242, L40222 and articles A60272 and A60239 before the October transition. Map service dates, test menus, ordering documentation and coverage screens to the finalized criteria. Have the appropriate billing and clinical owners assess any applicable beneficiary-notice duties instead of assuming every test is covered or denied from its name.
Implementation playbook
- Obtain L40242, L40222 and billing and coding articles A60272 and A60239, and record the covered indications and coding requirements for each. Coding · Due 2026-09-11
- Map the current thrombophilia and non next generation sequencing targeted panel test menu, in house and send out, against the finalized indications and list every test that loses or changes coverage. Clinical Operations · Due 2026-09-25
- Update the laboratory compendium, order sets, and medical necessity screening logic so the change takes effect on October 12, 2026 and the retired L36155 basis stops applying on October 11, 2026. IT · Due 2026-10-05
- Decide and document the advance beneficiary notice position for tests that become non covered, and brief the ordering services in writing. Revenue Cycle · Due 2026-10-09
- Audit a sample of thrombophilia and targeted panel claims in the first four weeks after the effective date and report the denial rate. Compliance · Due 2026-11-13
Sources
- MolDX Local Coverage Determination (LCD) Finalized, Effective October 12, 2026Official · Noridian Healthcare Solutions, Medicare Jurisdiction E · 2026-08-27 · Source review 2026-08-30
- MolDX: Genetic Testing for Hypercoagulability and Thrombophilia (L36155) Retirement, Effective October 11, 2026Official · Noridian Healthcare Solutions, Medicare Jurisdiction E · 2026-08-27 · Source review 2026-08-30
- MolDX hereditary thrombophilia, LCD L40242Official · CMS Medicare Coverage Database, Noridian · Source review 2026-10-15
- MolDX non-NGS targeted cancer panels, LCD L40222Official · CMS Medicare Coverage Database, Noridian · Source review 2026-10-15
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