MolDX: MGMT Promoter Methylation Analysis

Summary of Evidence Analysis of Evidence General Information Associated Information Sources of Information Bibliography Revision History Information Associated Documents Attachments Related Local Coverage Documents Related National Coverage Documents Public Versions Keywords Local Coverage Determination (LCD) MolDX: MGMT Promoter Methylation Analysis L35974 Expand All | Collapse All  Email Document  Download  Add to basket Contractor Information Contractor Name Contract Type Contract Number Jurisdiction States LCD Information Document Information LCD ID L35974 LCD Title MolDX: MGMT Promoter Methylation Analysis Proposed LCD in Comment Period N/A Source Proposed LCD DL35974 Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 10/14/2021 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date 08/20/2015 Notice Period End Date 10/04/2015 CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related co

Indications and Limitations of Coverage This policy provides limited coverage for methylation analysis for hypermethylation of the O-6-methylguanine DNA methyltransferase (MGMT) gene promoter. MGMT methylation analysis testing is considered to be reasonable and necessary for adult patients when the following criteria are met: Tumor type is high-­grade malignant glioma (e.g. glioblastoma multiforme (GBM), anaplastic astrocytoma) and Patients are able to tolerate temozolomide therapy or radiation therapy, and The physician will use the MGMT testing results to decide between radiation therapy and chemotherapy alone as 1st line adjuvant treatment, or between temozolomide and other chemotherapy for 1st line adjuvant treatment Note: This assessment is predicated on the assumption that therapy is considered beneficial for the specific patient.