I thought I had mentioned this new LCD, but maybe not.
On May 29, 2025, NGS MAC released a new final LCD, L39995, for pharmacogenomic testing. It will be effective July 12, 2025. The LCD serves MN/WI/IL and NY/New England.
The LCD largely matches a prior MOLDX coverage for pharmacogenomics, such as meeting CPIC A or B criteria or else being acknowledged on FDA labeling. Gene-specific testing is covered when a patient is considered for a drug that has a published PGX gene-drug pairing.
Find it here:
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39995&ver=5
The draft LCD was released for comment on October 3, 2024, comments closed on November 16.
The LCD covers the recent PGX panel code from AMA, which is 81418. 81418: Drug metabolism (e.g., pharmacogenomics) genomic sequence analysis panel, must include testing of at least 6 genes, including CYP2C19, CYP2D6, and CYP2D6 duplication/deletion analysis.
The billing article A59915 is rather complex, with 24 coding categories. This is quite different than the MolDx PGx article, A58324.
