LCDActive
MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer
L38329
Effective: July 3, 2025
Updated: December 31, 2025
Policy Summary
Molecular predictive classifiers for early-stage NSCLC are covered when the patient has non-squamous histology, AJCC 8th Edition Stage I or IIa disease, is a candidate to tolerate chemotherapy, and adjuvant platinum-based chemotherapy is being considered. The test must be ordered by the treating physician (medical oncologist, surgeon, or radiation oncologist) specifically to inform the adjuvant chemotherapy decision. Tests outside these criteria (e.g., squamous histology, not a chemotherapy candidate, different staging, or ordered for other purposes) are not covered.
Coverage Criteria Preview
Key requirements from the full policy
"Patient has non-squamous non-small cell lung cancer (NSCLC)."
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