Noridian finalizes two MolDX coverage policies for California effective October 12 and retires the thrombophilia policy October 11

What happened

Noridian's August 27, 2026 Jurisdiction E notices finalize two MolDX local coverage determinations for October 12: L40242 for hereditary thrombophilia and L40222 for non-next-generation-sequencing targeted molecular panels used for targeted cancer therapy. The corresponding billing articles are A60272 and A60239, with response-to-comment articles A60468 and A60509. The notices identify the covered contractor jurisdictions, including California, Hawaii, Nevada and Pacific territories. As of this October 4 edition, the finalized policies' effective date remained in the coming week.

A separate notice retires L36155, covering hypercoagulability and thrombophilia testing including Factor V Leiden, Factor II prothrombin and MTHFR, effective October 11 because L40242 supersedes it. That retirement date is distinct from the October 12 replacement date. These announcements identify which documents change and when; they do not say that every test in either family becomes noncovered. Laboratories and ordering services need the actual finalized indications and billing articles before mapping their test menus, date-of-service edits and beneficiary-notice decisions. An order date alone should not be treated as the coverage-effective date of a billed service.

Why it matters

Consecutive retirement and replacement dates require coordinated policy and coding maintenance, without assuming universal noncoverage for a test family.

Implementation playbook

1. 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
2. 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
3. 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
4. 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
5. 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 2026-09-06
• MolDX: Genetic Testing for Hypercoagulability and Thrombophilia (L36155) Retirement, Effective October 11, 2026Official · Noridian Healthcare Solutions, Medicare Jurisdiction E · 2026-08-27 · Source review 2026-09-06