Clinical Laboratory reimbursement alerts

This final LCD from WPS (J5/J8) governs molecular testing for solid organ allograft rejection and is now retired as of its last update, meaning coverage policies under L38680 are no longer active for

This final LCD from WPS (J5/J8) establishes coverage criteria for genetic testing related to hereditary thrombophilia, effective October 12, 2026, across six Midwestern states. Providers should review

This final LCD from CGS (J15) establishes coverage criteria for genetic testing related to hereditary thrombophilia under the MolDX program, effective October 12, 2026, for Kentucky and Ohio providers

This final LCD from Noridian (JE, JF) establishes coverage criteria for non-next generation sequencing (non-NGS) targeted molecular panel tests used to guide targeted therapy decisions in cancer patie

This final LCD from Noridian (Jurisdictions E and F) establishes coverage criteria for MolDX genetic testing for hereditary thrombophilia, effective October 12, 2026, across 15 Western and Mountain st

This final LCD from Palmetto GBA establishes coverage criteria for genetic testing related to hereditary thrombophilia, effective October 12, 2026, across seven southeastern states under Part A and Pa

CMS is updating NCD 210.3 for colorectal cancer screening via non-invasive biomarker tests, with claims processing changes effective January 4, 2027. Billing teams must review and update their coding

CMS is updating NCD 210.3 to revise coverage policy for non-invasive biomarker-based colorectal cancer screening tests under Medicare. Billing teams should prepare for updated coverage criteria, eligi

This transmittal implements the October 2026 quarterly update to the Clinical Laboratory Fee Schedule (CLFS), effective October 5, 2026. Billing teams should anticipate updated payment rates and poten

This active, final LCD from Wellpoint Federal governs coverage criteria for B-type Natriuretic Peptide (BNP) testing under both Part A and Part B, effective April 1, 2026. It establishes the indicatio

This final LCD from Wellpoint Federal establishes coverage criteria for heavy metal testing under Medicare Part A and B, effective April 1, 2026. It defines medically necessary indications for orderin

This active final LCD from Wellpoint Federal establishes coverage criteria for mass spectrometry testing in monoclonal gammopathy, effective April 1, 2026. It governs when MS-based diagnostic tests (s

This active Final LCD (L39726) from Wellpoint Federal establishes coverage criteria for KidneyIntelX and KidneyIntelX.dkd testing, effective April 1, 2026. It defines the conditions under which these

This final LCD from Wellpoint Federal establishes coverage criteria for pharmacogenomic testing under Medicare Part A and Part B, effective April 1, 2026. It defines when genetic testing to guide drug

This final LCD from Wellpoint Federal governs coverage criteria for urine drug testing under both Part A and Part B, effective April 1, 2026. It establishes the clinical indications, documentation req

This final LCD from Wellpoint Federal governs coverage of Vitamin D assay testing under Medicare Part A and Part B, effective April 1, 2026. It establishes specific clinical indications, documentation

This active final LCD from Wellpoint Federal governs coverage criteria for RAST (radioallergosorbent) type allergy tests under Medicare Part A and B, effective April 1, 2026. It establishes the indica

This final LCD from Palmetto GBA establishes coverage criteria for molecular testing used to detect solid organ allograft rejection, taking effect August 30, 2026. It applies to both Part A and Part B

This final LCD from Noridian (JE/JF) establishes coverage criteria for molecular testing used to detect solid organ allograft rejection, taking effect August 30, 2026. It will govern Medicare reimburs

This final LCD from Noridian establishes coverage criteria for molecular testing used to detect solid organ allograft rejection, effective August 30, 2026. It will define which patients, organ types,

This final LCD from WPS (J5/J8) establishes coverage criteria for molecular testing used to detect solid organ allograft rejection, effective August 30, 2026. It applies to Medicare Part A and Part B

This final LCD from CGS (J15) governs molecular testing for solid organ allograft rejection in Kentucky and Ohio, effective August 30, 2026. It establishes coverage criteria and documentation requirem

CMS is updating the Laboratory NCD Edit Software effective October 5, 2026, to reflect changes in National Coverage Determinations for lab services. Billing teams must review updated NCD edits in thei

This transmittal implements the July 2026 quarterly update to the Clinical Laboratory Fee Schedule (CLFS), effective July 6, 2026. Billing teams must update their lab fee schedule tables to reflect th

LCD L40272 establishes coverage criteria for MolDX biomarker testing in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH), ef

LCD L40199 covers MolDX biomarker testing for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH), effective 08/10/2026 under C

This future LCD (effective 08/10/2026) from Noridian covers MolDX biomarker testing for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepa

LCD L40187 governs MolDX biomarker testing for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH), effective August 10, 2026.

The upcoming public meeting for the Clinical Laboratory Fee Schedule will focus on new and reconsidered test codes, which could significantly influence payment amounts for laboratories. Stakeholders a

The upcoming public meeting will impact the reimbursement strategies for new and revised clinical diagnostic laboratory test codes under the Clinical Laboratory Fee Schedule (CLFS) for 2026. Stakehold

The upcoming public meeting on June 25, 2024, will address new and reconsidered clinical diagnostic laboratory test codes impacting the Clinical Laboratory Fee Schedule for 2025. Stakeholders will hav

The public meeting focuses on establishing payment amounts for new and revised laboratory test codes under the Clinical Laboratory Fee Schedule, potentially impacting reimbursement rates for diagnosti

The proposed local coverage determination (LCD) for histochemical and immunohistochemical stains could impact billing by clarifying guidelines and coverage for these laboratory tests. This may lead to

The proposed Local Coverage Decision regarding special histochemical and immunohistochemical stains may impact billing practices for laboratories. Providers should ensure that they have appropriate do

The proposed LCD by Palmetto GBA for molecular testing related to solid organ allograft rejection could impact billing significantly by establishing specific criteria for coverage. This may lead to in

The proposed Local Coverage Determination (LCD) for molecular testing related to solid organ allograft rejection could significantly influence billing practices for relevant tests. With proper coding,

The updated CLIA fees will impact reimbursement for clinical laboratory services, potentially increasing costs for laboratories while ensuring sustainable funding for the program. Enhanced fees for fo

The new MolDX coverage for hereditary transthyretin amyloidosis testing will provide reimbursement pathways for diagnostic molecular tests, benefiting patients and providers through enhanced testing a

The effective date of the LCD for Ionized Calcium indicates changes in the coverage and billing practices for this test. This may lead to adjustments in claims processing and reimbursement rates, requ

The implementation of the new LCD on Vitamin D Assay Testing will impact billing practices significantly. Providers will need to familiarize themselves with the new guidelines to ensure appropriate re

The introduction of the new LCD for Vitamin D Assay Testing by Noridian may affect billing practices, ensuring that healthcare providers follow updated guidelines for testing reimbursement. As a resul

The recent LCD regarding Vitamin D assay testing by Noridian may impact billing practices significantly, especially in terms of coverage and reimbursement rates. Providers must ensure compliance with

The introduction of the MolDX: Molecular Diagnostic Tests policy will significantly impact billing practices for molecular diagnostics, potentially leading to changes in reimbursement rates. It is cru

The LCD on Vitamin D Assay Testing by WPS may impact billing by clarifying coverage criteria which may lead to more denials for tests not meeting the outlined requirements. This could require provider

The new LCD for Cystatin C Measurement by Noridian, effective September 11, 2025, may impact billing practices for clinical laboratories. Providers will need to ensure compliance with the guidelines o

The introduction of new guidelines for Special Histochemical and Immunohistochemical Stains by Noridian may impact billing practices significantly. Providers should ensure they are familiar with the n

The new LCD on Special Histochemical and Immunohistochemical Stains is likely to impact lab billing practices significantly by specifying the criteria for coverage. Providers should ensure that their

The upcoming Local Coverage Determination for Cystatin C Measurement may impact billing practices significantly as of its effective date in February 2025. Providers will need to ensure they understand

The introduction of the MolDX Pharmacogenomics Testing LCD by Palmetto GBA may significantly impact the billing for genetic testing services within the specified effective date. Providers must ensure

The new LCD for Pharmacogenomics Testing by WPS may lead to supports compliance with updated rates practices for these tests. Providers will need to ensure that they meet the updated criteria to avoid claim de