Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 11201 | Palmetto GBA | A and B and HHH MAC | SC |
| 11301 | Palmetto GBA | A and B and HHH MAC | VA |
| 11401 | Palmetto GBA | A and B and HHH MAC | WV |
| 11501 | Palmetto GBA | A and B and HHH MAC | NC |
| 11202 | Palmetto GBA | A and B and HHH MAC | SC |
| 11302 | Palmetto GBA | A and B and HHH MAC | VA |
| 11402 | Palmetto GBA | A and B and HHH MAC | WV |
| 11502 | Palmetto GBA | A and B and HHH MAC | NC |
| 10111 | Palmetto GBA | A and B MAC | AL |
| 10211 | Palmetto GBA | A and B MAC | GA |
| 10311 | Palmetto GBA | A and B MAC | TN |
| 10112 | Palmetto GBA | A and B MAC | AL |
| 10212 | Palmetto GBA | A and B MAC | GA |
| 10312 | Palmetto GBA | A and B MAC | TN |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A59380 (Billing and Coding: MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneous Squamous Cell Carcinoma) 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.
A59380: Billing and Coding: MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneous Squamous Cell Carcinoma (Billing and Coding)
- Covered ICD-10-CM codes
- 0
- 0 groups
- Non-covered ICD-10-CM codes
- 24
- Procedure codes listed
- 2
- Full article
- cms.gov record
Procedure codes: 0315U, 81479.
Coverage indications, limitations and medical necessity
Current molecular biomarker tests that risk stratify individuals with cutaneous squamous cell carcinoma (cSCC) are non-covered by this contractor.
Summary of evidence (opening)
Clinical Background
Cutaneous squamous cell carcinoma (cSCC) is an epidermal keratinocyte-derived malignancy that is the second most common skin cancer. 1,2 Incidence is increasing and varies with latitude in the United States, with higher incidence in areas of greater sun exposure. 3 Each year, over 700,000 new cases are diagnosed, 5600 to 12,600 patients develop nodal metastasis, and there are 4000-8800 deaths. 2,4-7 Incidence is highest in non-Hispanic white populations, greater in males compared to females, and increases with age for a mean age at diagnosis of approximately 71 years. 3 Ultraviolet (UV) radiation due to cumulative and chronic sun exposure is the most important environmental risk factor, occurring more frequently in those with less pigmented skin types. 8-10 In individuals with highly pigmented skin, cSCC is more frequently found on non-sun exposed areas and is often associated with chronic inflammation, chronic wounds, or scarring. 4-7 cSCC of this etiology is more difficult to treat and exhibits a higher recurrence risk. 11-13
The overall prognosis is favorable with a 5-year survival of approximately 98%. 2,8,14 While most tumors are easily cured with surgical excision, a subset result in recurrence, metastasis, and disease-specific death. 14,15 The risk of nodal metastasis ranges from 1.2-5.8% in cohort and tumor registry studies and risk of death is approximately 2%. 14,16,17 In a cohort of patients treated with Mohs micrographic surgery (MMS), the rate of local recurrence was 2.5%, metastatic disease 1.9% and of disease-specific death 0.57%, 18 underscoring the importance of adequate surgical treatment.
Approaches to Risk-Stratification and Staging
The contractor cites 83 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2024-08-18
- Current revision effective
- 2024-08-18
- Last reviewed by the contractor
- 2024-05-15
- MCD version
- 3
Other related documents: A59815 (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 Palmetto GBA 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 L39583 cover?
Current molecular biomarker tests that risk stratify individuals with cutaneous squamous cell carcinoma (cSCC) are non-covered by this contractor. 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 L39583 apply to?
Palmetto GBA applies it to Medicare claims in AL, GA, NC, SC, TN, VA, WV. 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 L39583?
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 L39583?
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.