New molecular LCDs to take effect next month

April 19, 2019

Several Medicare Administrative Contractors (MACs) will soon have new Local Coverage Determinations (LCDs) in place for various FISH testing codes that will require providers to list a diagnostic code supporting medical necessity in order to receive payment.

The following codes are impacted: 88271, 88273, 88274, 88275 and 88291.

Effective dates:

Palmetto — 4/8/2019

CGS — 5/6/2019

WPS — 5/13/2019

Noridian — 6/3/2019

Below is a listing of diagnostic codes that support medical necessity. Failing to include an appropriate dx code will result in a denial of payment.

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