Noridian finalizes two MolDX coverage policies for California effective October 12 and retires the thrombophilia policy October 11
Oct 11, 2026 edition · GC-2026-0011 · Published 2026-10-11 · Version 3 · Final
Two finalized MolDX LCDs begin for services performed October 12, immediately after the older thrombophilia policy retires. Their distinct indications, validation requirements, and technical assessments prevent treating the transition as automatic coverage or blanket noncoverage.
What happened
Noridian's August notices finalize hereditary-thrombophilia LCD L40242 and non-NGS targeted-cancer-panel LCD L40222 for the listed Jurisdiction E contracts, with companion coding articles A60272 and A60239. The prior thrombophilia LCD L36155 retires October 11 because L40242 supersedes it. CMS specifies services performed on or after October 12 for the replacement's commencement. Retirement and next-day implementation are the material carryover events, rather than publication of a new October policy.
L40242 requires a qualifying clinical setting, management-relevant hereditary testing, appropriate validated genetic content, repeat-testing limits, and a satisfactory MolDX technical assessment. L40222 requires treatment-informing tumor testing and either infeasible NGS or the specified rapid, accurate alternative, together with validation and assessment requirements. Its negative non-NGS result may be followed by NGS covering additional necessary content; that exception does not waive the other criteria. Neither policy makes every named test covered, and references to companion articles do not replace their actual coding instructions.
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
Laboratories must use the operative indications and coding articles for hereditary thrombophilia and non-NGS targeted cancer panels. Retirement alone does not establish that every test becomes noncovered; each service must satisfy the applicable policy.
Recommended action
Coding and laboratory owners should complete the indication, technical-assessment and coding crosswalk today, implement the date-of-service rules October 12, and assess beneficiary notices where applicable. Review actual claims after implementation.
Implementation playbook
- Complete the laboratory indication, technical-assessment and coding crosswalk; confirm outstanding work immediately. Internal target. Coding · Due 2026-10-11
- Apply service-date controls for the finalized policies and assess beneficiary notices where applicable. Revenue Cycle · Due 2026-10-12
- Sample implementation claims and resolve policy-mapping errors. Internal target. 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 2026-10-11
- MolDX: Genetic Testing for Hypercoagulability and Thrombophilia (L36155) Retirement, Effective October 11, 2026Official · Noridian Healthcare Solutions, Medicare Jurisdiction E · 2026-08-27 · Source review 2026-10-11
- MolDX LCD L40242, operative date and coverage criteriaOfficial · CMS Medicare Coverage Database · 2026-08-27 · Source review 2026-10-11
- MolDX LCD L40222, operative date and coverage criteriaOfficial · CMS Medicare Coverage Database · 2026-08-27 · 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.
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