MolDX: Minimal Residual Disease Testing for Cancer

This policy provides limited coverage for MRD testing (PCR- or sequencing-based) in patients with a personal history of cancer when the test is analytically and clinically validated for the intended-use population and meets guideline-based requirements demonstrating that detection of recurrence/progression would change management. NGS-based tests must meet NCD 90.2 when applicable, non–FDA-approved tests must complete a technical assessment, and testing frequency and single-gene PCR schedules follow national or society guidelines.

"MRD testing is covered when the patient has a personal history of cancer and the cancer type and stage fall within the test's intended use."

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