MolDX: Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia
L39262
Molecular diagnostic tests for detection of upper gastrointestinal metaplasia, dysplasia, and neoplasia are not covered by this contractor unless a specific set of criteria are met, including active management of chronic GERD or non-dysplastic Barrett’s esophagus, ≥3 additional guideline-defined Barrett’s risk factors, no prior dysplasia or esophageal cancer, and testing performed within validated populations and guideline-recommended intervals. Coverage also requires analytical and clinical validation with peer-reviewed evidence, laboratory documentation of intended population, and successful completion of the contractor’s Technical Assessment demonstrating the test is Reasonable and Necessary.
"Beneficiary is being actively managed for chronic gastroesophageal reflux disease (GERD) and/or non-dysplastic Barrett’s esophagus (NDBE)."
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