LCDActive
MolDX: MGMT Promoter Methylation Analysis
L37001
Wisconsin Physicians Service Insurance Corporation (J05)
Effective: September 25, 2025
Updated: December 31, 2025
Policy Summary
MGMT promoter methylation analysis is limitedly covered for adult patients (>=18) with high-grade malignant glioma (e.g., GBM or anaplastic astrocytoma) when the patient can tolerate temozolomide or radiation and the physician will use the result to guide first-line adjuvant therapy decisions (radiation vs chemotherapy or temozolomide vs other chemotherapy). Testing is not indicated for other tumor types, for patients unable to tolerate those therapies, or when results will not affect first-line adjuvant treatment or when adjuvant therapy is not considered beneficial.
Coverage Criteria Preview
Key requirements from the full policy
"MGMT promoter methylation analysis is covered to detect hypermethylation of the MGMT gene promoter."
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