Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57566 (Billing and Coding: MolDX: Decision Dx-UM (Uveal Melanoma)) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A57566: Billing and Coding: MolDX: Decision Dx-UM (Uveal Melanoma) (Billing and Coding, effective 2025-05-28)
- Covered ICD-10-CM codes
- 6
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 1
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| C69.31 | — |
| C69.32 | — |
| C69.41 | — |
| C69.42 | — |
| C69.91 | — |
| C69.92 | — |
Procedure codes: 81552.
Coverage indications, limitations and medical necessity
This Medicare contractor will provide limited coverage for the DecisionDx-UM (Castle Bioscience, Inc.) test for the management of newly diagnosed uveal melanoma. This test is intended for the determination of metastatic risk, and to guide surveillance and referral to medical oncology (preferably an oncologist with expertise in melanoma) in patients who have a confirmed diagnosis of uveal melanoma (UM) and no evidence of metastatic disease.
Summary of evidence (opening)
UM is a rare cancer, affecting ~1600-1700 patients per year in the United States, but it is the most common intra-ocular cancer in adults. UM arises in the middle layer of the eye, the uvea tract, which consists of the iris, ciliary body, and choroid. Eye-sparing radiation (brachytherapy or proton beam therapy) is the most common treatment approach, but approximately 10% of patients will undergo enucleation due to large and/or aggressive tumors that cannot be managed with radiation or due to eye pain or vision loss. Local treatment by radiation or enucleation is highly successful at controlling the primary tumor, with only ~5% chance of local recurrence. Most patients present with local disease and no evidence of metastases, however, as many as 50% of patients will ultimately experience distant metastasis, most commonly to the liver.
Clinicopathologic staging cannot reliably identify patients at low or high risk of metastasis, as even early-stage patients (AJCC Stage I-II) have a substantial risk of metastasis and mortality. Historically, most UM patients were managed with high intensity surveillance, including frequent imaging and laboratory tests, with the goal of diagnosing early metastasis. Systematic imaging has been shown to be effective at identifying asymptomatic metastases, which is important because treatment of liver metastases with surgical resection or regional therapy is more effective and achieves better outcomes when tumor burden is low. However, since approximately 50% of patients will not experience metastasis, a substantial proportion of patients were subjected to unnecessary imaging, laboratory tests, and clinical visits, resulting in patient burden, undo exposure to radiation and over-utilization of healthcare resources.
An accurate determination of metastatic risk at diagnosis allows for a risk-appropriate surveillance program. Patients at high-risk of metastasis can continue to be followed with a high intensity program as previously prescribed, such as quarterly ultrasound, magnetic resonance imaging (MRI) or computerized tomography (CT) scans alternating with liver function tests (LFTs), and consideration of adjuvant treatment. These patients benefit from early detection of metastatic disease when it can be most effectively treated. Patients with low metastatic risk can be removed from this traditional intensive surveillance and instead followed with a low intensity program, such as yearly exams, imaging, and LFTs.
DecisionDx-UM Test Description and Intended Use
The contractor cites 7 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2017-09-16
- Current revision effective
- 2026-05-28
- Last reviewed by the contractor
- 2025-05-01
- MCD version
- 21
Other related documents: A55643 (Response to Comments).
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Wisconsin Physicians Service Insurance Corporation hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L37210 cover?
This Medicare contractor will provide limited coverage for the DecisionDx-UM (Castle Bioscience, Inc.) test for the management of newly diagnosed uveal melanoma. This test is intended for the determination of metastatic risk, and to guide surveillance and referral to medical oncology (preferably an oncologist with expertise in melanoma) in patients who have a confirmed diagnosis of uveal melanoma (UM) and no… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L37210 apply to?
Wisconsin Physicians Service Insurance Corporation applies it to Medicare claims in AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L37210?
The companion billing and coding article A57566 lists 6 ICD-10-CM codes in 1 group that support medical necessity; the first 6 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L37210?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.