About this policy
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)
ProMark® Risk Score
L36665
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Contractor Information
Contractor Name Contract Type Contract Number Jurisdiction States
LCD Information
Document Information
LCD ID
L36665
LCD Title
ProMark® Risk Score
Proposed LCD in Comment Period
N/A
Source Proposed LCD
DL36665
Original Effective Date
For services performed on or after 10/10/2016
Revision Effective Date
For services performed on or after 12/30/2021
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
08/23/2018
Notice Period End Date
10/07/2018
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 components are not assigned by the AMA, are no
Coverage indications
This Contractor will provide limited coverage for the ProMark ® (Metamark Genetics) to help determine which patients with early stage, needle biopsy proven prostate cancer can be conservatively managed rather than treated with definitive surgery or radiation therapy.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Backwork has no codes on record for this policy. Check the source.