Noridian posts MolDX billing-article revisions for October 1
Oct 11, 2026 edition · GC-2026-0134 · Published 2026-10-11 · Version 3 · Final
MolDX article revisions combine October diagnosis-code maintenance with older effective coding clarifications and a hyperlink repair. Test-specific claim conditions remain relevant after implementation; an added code does not by itself establish coverage.
What happened
For October 1, A57891 adds M04.3; A59868 adds Q87.A; and A60217 adds K74.0A. A59872 replaces I42.0 and I42.8 with more specific cardiomyopathy codes, while A57037 replaces I42.0 with I42.00, I42.01, and I42.09. These annual code changes have different scope from the other revision entries: A59872 separately dates its I42.1 and I42.2 additions to September 25, 2025, and the sequencing-code inclusion language in A57891 and A57901 is effective May 17, 2020. A55595 describes its September 24 change as a revised hyperlink.
The MASLD/MASH article A60217 retains operational limits beyond its new diagnosis code: one test per patient per twelve months, one unit of service, the appropriate DEX identifier, and at least one diagnosis from each of the liver-dysfunction and cardiometabolic-risk groups. The amyloidosis and aortic-disease articles point to the DEX registry for tests evaluated against coverage criteria. The sequencing articles expressly caution that inclusion of 81455 and 81456 does not imply coverage and does not adequately define a particular service. Reviewing implemented edits therefore requires the relevant article and testing conditions, rather than treating this bundle as one new blanket testing benefit.
Scope and timing
- Authority status
- Final
- Applicability
- Directly applicable
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal, California
- Affected functions
- Clinical Operations, Revenue Cycle, Coding, Compliance
- Responsible owner
- Revenue Cycle
- Recorded date
- 2026-10-01
- Date type
- implementation
Why it matters
California laboratories and ordering providers need to confirm that applicable October 1 coding, documentation and claim edits are operating correctly. The effective date has passed; code inclusion alone does not establish coverage.
Recommended action
Inventory the revised articles that apply to current testing, reconcile the implemented October 1 changes with local edits and order workflows, and sample current claims for diagnosis, DEX identification and test-specific coverage requirements. Correct any implementation gaps promptly.
Implementation playbook
- Identify revised MolDX articles tied to tests currently ordered or billed and confirm the applicable LCD criteria. Clinical Operations · Due 2026-10-12
- Reconcile implemented October 1 coding, documentation and claim edits; correct any gaps. Coding · Due 2026-10-13
- Sample current claims and document any remaining coding or coverage-control failures. Revenue Cycle · Due 2026-10-14
Sources
- JE Part B Latest UpdatesOfficial · Noridian Healthcare Solutions · 2026-09-27 · Source review 2026-09-27
- MolDX operative billing article A57891Official · CMS Medicare Coverage Database / Noridian · Source review 2026-10-11
- MolDX operative billing article A59872Official · CMS Medicare Coverage Database / Noridian · Source review 2026-10-11
- MolDX operative billing article A59868Official · CMS Medicare Coverage Database / Noridian · Source review 2026-10-11
- MolDX operative billing article A57037Official · CMS Medicare Coverage Database / Noridian · Source review 2026-10-11
- MolDX operative billing article A60217Official · CMS Medicare Coverage Database / Noridian · Source review 2026-10-11
- MolDX operative billing article A55595Official · CMS Medicare Coverage Database / Noridian · Source review 2026-10-11
- MolDX operative billing article A57901Official · CMS Medicare Coverage Database / Noridian · Source review 2026-10-11
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
Read the entire Medicare & Medicaid report →