MolDX Inherited Cancer Syndromes LCD: What the August 2026 Billing Article Changes Mean for Labs
Short answer: Medicare's MolDX policy covers germline testing for patients with any cancer diagnosis, a clinical indication, a germline risk factor, and no prior test of the same content, but only for tests that completed a MolDX Technical Assessment. Noridian's August 2026 billing article added codes 81288 and 0138U, then removed them a week later.
What does the MolDX inherited cancer syndromes policy cover?
The policy is titled "MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer." It exists as a parallel local coverage determination at each MolDX contractor. According to the CMS Medicare Coverage Database, Noridian publishes it as L38972, CGS Administrators as L39017, WPS as L39040, and Palmetto GBA as L38966. The Noridian version currently in effect applies to services performed on or after February 5, 2026; its original effective date was August 8, 2022. Noridian's earlier L38974 shows a retirement date of February 5, 2026.
The scope is narrow by design. The Noridian text states that the policy is "specific for hereditary germline testing, and is exclusive of polygenic risk scores." Specific genes and variants are not listed in the LCD itself; they sit in associated documents such as the MolDX Technical Assessment forms. For clinical context on which patients are typically considered for this testing, see our overview of NCCN hereditary cancer testing guidelines.
Which patient criteria must be met?
The LCD states that all of the following must be present for coverage eligibility. The patient must have any cancer diagnosis, a clinical indication for germline testing for hereditary cancer, and a risk factor for germline cancer, and must not have been previously tested with the same germline genetic content. The criteria are cumulative. A claim that documents a cancer diagnosis but no stated clinical indication or risk factor does not meet the policy as written.
The duplicate-testing language deserves attention. The policy says a subsequent test is only reasonable and necessary if it contains non-duplicative genetic content. A lab that receives a repeat order for a patient who already had a panel with overlapping genes cannot assume the second panel is covered; the ordering clinician's documentation should identify what new content is being tested and why.
What must the test itself satisfy?
Patient eligibility is only half of the test. The LCD requires that the test has satisfactorily completed a Technical Assessment by the MolDX Molecular Diagnostic Services Program and includes at least the minimum genetic content, meaning the genes or genetic variants the assessment requires. A single gene or variant may be tested if it is the only one considered reasonable. If the test is a next-generation sequencing test, it must also abide by all conditions in National Coverage Determination 90.2.
The policy lists the circumstances that lead to non-coverage. These include a Technical Assessment that was not satisfactorily completed, and complete Technical Assessment materials that were not submitted by the original effective date of the policy. Providers that need MolDX to complete an assessment must submit documentation, and the LCD states that testing will be non-covered unless complete documents are submitted in a timely manner. For labs, this makes the assessment status of each test on the menu a billing prerequisite, not an administrative afterthought.
What happened with billing article A58679 in August 2026?
The billing and coding article attached to the policy carries the code and diagnosis lists that claim edits depend on. Noridian's article A58679 was revised twice in August 2026. Revision 12, effective August 6, 2026, added a reference to the DEX registry for checking whether specific tests meet the policy's coverage criteria. It also added new group labels: "Single genes and solid tumor panels" and "Hematologic neoplasm panels" on the CPT/HCPCS side, and "Solid tumors" and "Hematologic neoplasms" on the ICD-10 side. It added codes 81288 and 0138U.
Revision 13, effective August 13, 2026, deleted 0138U and 81288. The article states: "The addition of these codes in Revision 12 was done in error." No other codes were listed as added in that revision. The R13 page lists Jurisdiction F contract numbers for Alaska, Idaho, Oregon, Washington, Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming.
The practical lesson is about timing. A lab or billing vendor that loaded the R12 code list into a claim scrubber between August 6 and August 13 may have built edits around two codes that the contractor then withdrew. The search results in the CMS database also show that the other MolDX contractors carry parallel articles: WPS A58756 and CGS A58734 and Palmetto A58652, each with an August 6, 2026 effective date, while Noridian's A58679 now shows August 13, 2026.
What should lab and revenue cycle teams do now?
First, confirm which MAC and which billing article version governs each claim. Contractors publish separate articles, and the version in effect depends on the date of service. Second, if your claim edits were updated from the R12 list, check whether 81288 or 0138U were added as covered for this policy and remove that logic. Both codes were withdrawn from A58679, which means the article no longer supports using it as a basis for coverage of those codes.
Third, keep a test-by-test record of the Technical Assessment status that MolDX has assigned, and use the DEX registry reference that R12 added as your starting point for verification. Fourth, build the four patient criteria into pre-submission review so that documentation of the cancer diagnosis, the clinical indication, the germline risk factor, and prior testing history is checked before a claim is dropped. Our guide to genetic testing denials explains how missing documentation turns into denials, and the ICD-10 hereditary cancer code guide helps with the diagnosis side.
One limitation applies to everything above. The CPT/HCPCS and ICD-10-CM code tables in the CMS database sit behind a license prompt and could not be read in full for this review. Labs should confirm complete code lists directly in the current billing article for their contractor. For related contractor activity in the same period, see our summary of MolDX August 2026 LCD updates. Teams that want coverage and coding checks built into the order-to-claim workflow can learn more at ScreenMyGene.
Frequently asked questions
Does the MolDX inherited cancer policy cover polygenic risk scores?
No. The LCD text states that the policy is specific for hereditary germline testing and is exclusive of polygenic risk scores. Labs should not use this policy as the basis for billing a polygenic risk score, and should check the relevant contractor guidance for any such offering instead.
What patient criteria does the policy require?
All four must be present: any cancer diagnosis, a clinical indication for germline testing for hereditary cancer, a risk factor for germline cancer, and no previous test of the same germline genetic content. Documentation should show each element before the claim is submitted.
Why does the Technical Assessment matter?
The test must have satisfactorily completed a MolDX Technical Assessment and include the minimum genetic content. If the assessment is not satisfactorily completed, the policy lists that as a non-coverage situation, so assessment status is a billing prerequisite for each test.
Were codes 81288 and 0138U added to the billing article?
Briefly. Noridian's A58679 revision 12, effective August 6, 2026, added them, and revision 13, effective August 13, 2026, deleted both, stating the addition was done in error. Labs should not rely on the R12 list for these two codes, and should confirm current code lists.
Is a repeat panel covered for the same patient?
Only if it adds non-duplicative genetic content. The LCD says a subsequent test is reasonable and necessary only when the content is non-duplicative, and it excludes patients previously tested with the same germline genetic content, so ordering documentation should state what is new.
This article is educational and intended for laboratory and revenue cycle professionals. It is not legal, coding, or reimbursement advice and does not replace payer or CMS documents. Verify all policy text and code lists against the current LCD and billing article for your Medicare Administrative Contractor before billing.
Sources: CMS Medicare Coverage Database, MolDX LCDs L38972, L39017, L39040, L38966, L38974 and billing articles A58679, A58756, A58734, A58652 (accessed October 10, 2026); Noridian Medicare, "Billing and Coding: MolDX: Lab Developed Tests for Inherited Cancer Syndromes in Patients with Cancer (A58679) R12 effective August 6, 2026" and R13 effective August 13, 2026.