About this policy
Jurisdiction: JJ Part B. States: Alabama, Georgia, Tennessee. Type: Active LCD
Coverage indications
This policy describes and clarifies coverage for Lab-Developed Tests (LDTs), Food and Drug Administration (FDA)-cleared, and FDA-approved clinical laboratory tests utilizing Next-Generation Sequencing (NGS) in cancer as allowable under the National Coverage Determination (NCD) 90.2, under section D describing Medicare Administrative Contractor (MAC) discretion for coverage. This policy’s scope is specific for solid tumor testing, and is exclusive of hematologic malignancies, circulating tumor DNA testing (ctDNA), and other cancer-related uses of NGS, such as germline testing in/for patients with cancer.
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.
| Code | Code system | Status in this policy |
|---|---|---|
| 81445 | CPT | Covered |
| 81449 | CPT | Covered |
| 81455 | CPT | Covered |
| 81456 | CPT | Covered |
| 81457 | CPT | Covered |
| 81458 | CPT | Covered |
| 81459 | CPT | Covered |
| 81479 | CPT | Covered |
| 0244U | HCPCS | Covered |
| 0250U | HCPCS | Covered |
| 0329U | HCPCS | Covered |
| 0334U | HCPCS | Covered |
| 0379U | HCPCS | Covered |
| 0543U | HCPCS | Covered |