LCDActive
MolDX: Decision Dx-UM (Uveal Melanoma)
L37210
Wisconsin Physicians Service Insurance Corporation (J05)
Effective: June 27, 2024
Updated: December 31, 2025
created · Nov 30, 2025
Policy Summary
This contractor provides limited coverage for the DecisionDx-UM test for management of newly diagnosed uveal melanoma to determine metastatic risk and guide surveillance and referral to medical oncology. Coverage is limited to patients with a confirmed UM diagnosis and no clinical or radiographic evidence of metastatic disease. Documentation of diagnosis, absence of metastasis, and intended use of results to guide management is expected.
Coverage Criteria Preview
Key requirements from the full policy
"Patient has a confirmed diagnosis of uveal melanoma (UM) by appropriate clinical and/or pathologic evaluation."
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