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 A58795 (Billing and Coding: Genetic Testing for Cardiovascular Disease) 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.
A58795: Billing and Coding: Genetic Testing for Cardiovascular Disease (Billing and Coding, effective 2025-01-01)
- Covered ICD-10-CM codes
- 0
- 0 groups
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 22
- Full article
- cms.gov record
Procedure codes: 0119U, 0237U, 0401U, 0466U, 81161, 81401, 81402, 81403, 81404, 81405, 81407, 81408, 81410, 81411, 81413, 81414, 81415, 81416, 81417, 81439, 81442, 81493.
Coverage indications, limitations and medical necessity
Compliance with the provisions in this LCD may be monitored and addressed through post payment data analysis and subsequent medical review audits.
History/Background and/or General Information
With advancement in science and technology comes the ability to incorporate genetic testing for hereditary cardiovascular disease into clinical care, with the goal of improved patient outcomes. The scope of this LCD is genetic testing in the practice of cardiovascular medicine in the Medicare population.
The genetic basis of cardiovascular disease is an area of rapidly expanding knowledge. To date, identification of genetic variants associated with cardiovascular disease includes hypertrophic and dilated cardiomyopathy (associated with mutations in sarcomere and structural genes), arrhythmogenic cardiomyopathy (associated with mutations in desmosome genes), inherited arrhythmias (associated with mutations in transmembrane ion channels genes), and Marfan and related syndromes (associated with mutations in genes encoding connective tissue elements). Association does not necessarily translate to improvement in patient care.
In certain circumstances, genetic testing for inherited cardiovascular disease in patients with the corresponding appropriate phenotypic medical condition could have the potential to assist patient management in the Medicare population. However, given the complexity and rapidly expanding knowledge in this topic area, there is also a potential for testing that does not help the patient or leads to confusion. Specialized clinical expertise in cardiovascular medicine in addition to advanced knowledge in both genetic variation and effect on gene function is required to facilitate optimal outcomes for patients.
Covered Indications
Genetic testing for hereditary cardiovascular disease will be considered medically reasonable and necessary if:
• The patient has rigorous disease-appropriate phenotyping to establish clinical diagnosis or suspected diagnosis for which the test results would directly impact the management of the patient’s condition, prior to ordering the test
AND
• The evidence for the gene-disease association is evaluated by the evidence-based, transparent, peer-reviewed process of the National Institutes of Health (NIH) sponsored Clinical Genome Resource (ClinGen) and is determined to demonstrate actionability in clinical decision making, meeting all bulleted metrics:
• Disease severity of sudden death, possible death or major morbidity, modest morbidity
• Substantial or moderate evidence of a >40% likelihood of disease
• Substantial or moderate evidence of a highly effective or moderately effective intervention
• The nature of intervention is either low risk/medically acceptable/low intensity intervention or moderately acceptable/risk/intensive interventions,
AND
• Clinical validity and qualitative descriptors from Moderate, Strong & Definitive with contradictory evidence NOT being reported as disputed or refuted.
Limitations
The following are considered not medically reasonable and necessary:
• A genetic test where either analytical validity, clinical validity, or clinical utility has not been established.
• Genetic testing in patients who do not demonstrate the disease-appropriate phenotype of the gene-disease association.
• Genetic testing of asymptomatic patients.
• Genetic testing solely for purposes of proband identification.
• Genetic testing with family history as the only indication.
• Gene tests for cardiovascular disease are considered germline testing, and therefore only permitted once per beneficiary’s lifecycle.
Provider Qualifications
The ordering provider of a genetic test for a patient with a cardiovascular disease-appropriate phenotype:
• Must be the treating clinician who is responsible for the cardiovascular disease management of the patient’s condition; and,
• Understands how the test result will impact the patient’s condition; and,
• Has presented this information to the patient eliciting patient understanding.
Notice: Services performed for any given diagnosis must meet all of the indications and limitations stated in this LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
Summary of evidence (opening)
Introduction
The focus of this evidence review is on genetic testing to assess clinical actionability in cardiovascular disease, and whether the evidence is adequate to draw conclusions about improved health outcomes for the Medicare population. In general, improved health outcomes of interest include patient mortality and morbidity, as well as patient quality of life and function. For genetic testing to be considered medically reasonable and necessary in the Medicare population, standardized evaluation of analytical validity, clinical validity, and clinical utility should be fully elucidated, and reflect the level of confidence that the performance of this test will directly benefit patients. Tests with analytic and clinical validity, with demonstrated clinical utility that provide confidence to accurately enhance clinician decision-making and satisfy requirements for accurate patient information, have the potential to alter clinical management leading to improved patient outcomes. Ideal patient outcomes demonstrate reduced mortality and morbidity and improved patient quality of life and function.
Genetic testing for genetic variants associated with cardiovascular disease endeavors to improve patient outcomes by guiding appropriate treatment, thereby maximizing treatment effectiveness. Outcomes of interest remain the patient-centered outcomes noted above.
Internal Technology Assessment
The contractor cites 16 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2022-01-30
- Current revision effective
- 2022-01-30
- MCD version
- 6
Other related documents: A58955 (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 Novitas Solutions, Inc. hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L39082 cover?
With advancement in science and technology comes the ability to incorporate genetic testing for hereditary cardiovascular disease into clinical care, with the goal of improved patient outcomes. The scope of this LCD is genetic testing in the practice of cardiovascular medicine in the Medicare population. 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 L39082 apply to?
Novitas Solutions, Inc. applies it to Medicare claims in AR, CO, DC, DE, LA, MD, MS, NJ, NM, OK, PA, TX. 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 L39082?
The current export links no billing and coding article with a diagnosis list to this LCD, so coverage is decided on the indications in the policy text and the documentation in the record rather than by an automated diagnosis edit.
How do I appeal a denial under LCD L39082?
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.