MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer

Molecular diagnostic classifiers (DNA/RNA/protein) are considered reasonable and necessary for early-stage non-squamous NSCLC when the patient is a candidate for and adjuvant platinum-containing chemotherapy is being considered, and the test is ordered by the treating NSCLC physician. The policy references a tumor size threshold but does not specify the numeric value; documentation must include a physician order and evidence that adjuvant chemotherapy is being considered. Verify local Medicare contractor requirements for any additional documentation or prior authorization.

"Molecular diagnostic tests (DNA, RNA, and/or protein-based) used as predictive classifiers for non-small cell lung cancer (NSCLC) are covered when the tumor is non-squamous histology."

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