Reimbursement Policy Evidence

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CPT procedure code

0242U

Medicare payment

$5,000.00

2026 Clinical Laboratory Fee Schedule

Source: CMS Clinical Laboratory Fee Schedule (2026). CMS fee schedules ↗

National amount before geographic adjustment. Your MAC's locality rate will differ.

Code definition

Code

0242U

Code system

CPT (Current Procedural Terminology)

This CPT code is not in our curated reference. CPT codes are maintained by the American Medical Association (AMA). Full descriptions require an AMA license.

Category

—

Short description sourced from CMS publicly available fee schedule data. Full CPT descriptions are copyright AMA. Not a substitute for the official CPT codebook.

Policy activity for CPT 0242U

CLV Intelligence is tracking 9 policy changes that cite CPT 0242U between 2026-06-05 and 2026-09-24, drawn from 7 LCD/NCD coverage updates and 2 proposed LCDs. The changes span Clinical Laboratory and Oncology. 5 are flagged critical or high priority.

LCD/NCD coverage updates: 7
proposed LCDs: 2

Counts reflect the source documents CLV has matched to CPT 0242U to date; each links to the government publication that is authoritative. Monitored daily from CMS, the Federal Register, and Medicare Administrative Contractor publications.

Policy changes matched to 0242U

Matched to this code by CLV analysis of each policy. The linked source document is authoritative.

Proposed LCD DL40427: MolDX: Next-Generation Sequencing for Hematologic Malignancies and Suspected Hematologic Malignancies — Noridian

Oncology · LCD-DL40427

Government source· CMS / MACverify ↗

Critical

Full analysis available with a CLV subscription.

LCD L36021: MolDX: Molecular Diagnostic Tests (MDT) — CGS

Clinical Laboratory · LCD-L36021

Government source· CMS / MACverify ↗

High

Full analysis available with a CLV subscription.

LCD L36256: MolDX: Molecular Diagnostic Tests (MDT) — Noridian

Clinical Laboratory · LCD-L36256

Government source· CMS / MACverify ↗

High

Full analysis available with a CLV subscription.

LCD L35160: MolDX: Molecular Diagnostic Tests (MDT) — Noridian

Clinical Laboratory · LCD-L35160

Government source· CMS / MACverify ↗

High

Full analysis available with a CLV subscription.

Proposed LCD DL40472: MolDX: Next-Generation Sequencing for Hematologic Malignancies and Suspected Hematologic Malignancies — WPS

Oncology · LCD-DL40472

Government source· CMS / MACverify ↗

High

Full analysis available with a CLV subscription.

LCD L38168: MolDX: Plasma-Based Genomic Profiling in Solid Tumors — WPS

Oncology · LCD-L38168

Government source· CMS / MACverify ↗

Routine

Full analysis available with a CLV subscription.

LCD L38043: MolDX: Plasma-Based Genomic Profiling in Solid Tumors — Palmetto GBA

Oncology · LCD-L38043

Government source· CMS / MACverify ↗

Routine

Full analysis available with a CLV subscription.

LCD L38779: MolDX: Minimal Residual Disease Testing for Cancer — Palmetto GBA

Oncology · LCD-L38779

Government source· CMS / MACverify ↗

Low

Full analysis available with a CLV subscription.

LCD L37903: MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer — CGS

Oncology · LCD-L37903

Government source· CMS / MACverify ↗

Low

Full analysis available with a CLV subscription.

Audit documentation

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