MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer

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: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer L38238 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 L38238 LCD Title MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer Proposed LCD in Comment Period N/A Source Proposed LCD DL38238 Original Effective Date For services performed on or after 06/14/2020 Revision Effective Date For services performed on or after 07/03/2025 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date 04/30/2020 Notice Period End Date 06/13/2020 CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedul

This policy concerns the use of molecular diagnostic laboratory tests (tests of deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and / or proteins) as a predictive classifier for non-small cell lung cancer (NSCLC). Molecular classifiers are considered reasonable and necessary when beneficiaries meet all of the following criteria : The patient has a non-squamous NSCLC with a tumor size i.e. American Joint Committee on Cancer (AJCC) Eighth Edition Stages I and IIa) The patient is sufficiently healthy to tolerate chemotherapy Adjuvant platinum-containing chemotherapy is being considered for the patient The test is ordered by a physician who is treating the patient for NSCLC (generally a medical oncologist, surgeon, or radiation oncologist) to help in the decision of whether or not to recommend adjuvant chemotherapy