Genetic Testing for Oncology
L39668
Medicare covers DNA and RNA oncology genetic testing only for patients with an established cancer diagnosis or substantiated suspicion (clinical evaluation plus abnormal histology/cytology/flow cytometry), limited to the molecular tests specified in the LCD (with specific assays excluded such as DecisionDx‑Melanoma/SCC, many Cxbladder tests, Colvera, PancreaSeq, PancraGEN, ThyroSeq CRC, etc., and germline hereditary testing limited to once per beneficiary). Coverage requires demonstrated analytic/clinical validity and clinical utility, clinical actionability per ClinGen, NCCN, or OncoKB (and compliance with NCD 90.2/FDA requirements for DNA‑only NGS), documentation that the ordering provider is the treating clinician who has counseled the patient and that results will directly inform management.
"Scope: DNA and RNA genetic testing in the practice of oncology in the Medicare population."