On January 22, 2019, Genomeweb published an article that Palmetto MolDx germline BRCA testing LCDs were being updated to include references to CMS NCD 90.2, on NGS testing in cancer, which could be interpreted to block germline testing in Stage 1/2 cancer patients. I had pointed out this issue related to a Palmetto MolDx LCD revision on January 1, 2019 (here).
This week, the Noridian MAC contractor, which handles Mountain and West Coast states, published the same revision to a mirror LCD. See revision to LCD L36163 here.
The revision includes a header section reference to the NCD ( ^ "National Coverage Determination (NCD90.2): Next Generation Sequencing (NGS), which describes the criteria under which contractors may cover NGS laboratory tests for patients with cancer." Under panel testing, there are some new sentences of text that say that in addition to LCD criteria (e.g. a personal history of cancer), all NCD criteria apply as well. The NCD directed coverage to advanced (e.g. stage 3/4 cancer) when NGS method testing is used.
Personally, I think the NCD is materially ambiguous as to whether, taken as a whole, germline tested is described as out of scope (here).