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 A59872 (Billing and Coding: MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis) 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.
A59872: Billing and Coding: MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis (Billing and Coding, effective 2026-10-01)
- Covered ICD-10-CM codes
- 19
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 2
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| E85.0 | — |
| E85.1 | — |
| E85.2 | — |
| E85.3 | — |
| E85.4 | — |
| G57.90 | — |
| G57.91 | — |
| G57.92 | — |
| G57.93 | — |
| G59 | Mononeuropathy in diseases classified elsewhere |
| G60.3 | — |
| G60.9 | — |
| I42.01 | — |
| I42.09 | — |
| I42.1 | — |
| I42.2 | — |
| I42.81 | — |
| I42.89 | — |
| I43 | Cardiomyopathy in diseases classified elsewhere |
Procedure codes: 81404, 81479.
Coverage indications, limitations and medical necessity
This contractor will cover molecular diagnostic tests for use in the evaluation and management of beneficiaries suspected of having Hereditary Transthyretin Amyloidosis (hATTR) when all the following criteria are met:
• The patient has a clinical diagnosis of ATTR; OR
• Has cardiac features suggestive to ATTR-cardiomyopathy: AND
• Is of African ancestry; OR
• Has a first-degree relative with an hATTR diagnosis; OR
• Has at least one additional feature suggestive of hATTR according to expert consensus and society guidelines.
• Has progressive sensorimotor and/or autonomic neuropathy; AND
• Has a first-degree relative with an hATTR diagnosis; OR
• Has at least one additional features suggestive of hATTR according to expert consensus and society guidelines.
• The patient has been offered counseling regarding the test and potential results.
• The results of the test will be used to aid in treatment decisions.
• The test performed includes at least the minimum genetic content (genes or genetic variants) with definitive or well-established guidelines-based evidence required for clinical decision making for its intended use that can be reasonably detected by the test.
• The test does not include additional genetic content that is not properly validated, or of unclear clinical validity or utility such that it could reasonably or possibly be mis-utilized by the patient or treating physician and result in impaired patient outcomes.
• A single variant may be tested if it is the only variant considered to be reasonable and necessary for a patient given that it is a known familial variant.
• The test has successfully completed a technical assessment (TA) that ensures the test is reasonable and necessary as described above.
Summary of evidence (opening)
Background
Transthyretin is a protein produced in the liver, choroid plexus, and retinal pigment epithelium and transports thyroid hormone thyroxine and the retinal-binding protein bound to retinol. 1,2 In transthyretin amyloidosis (ATTR) the homotetrameric protein is destabilized, leading to monomers that misfold, aggregate and form amyloid fibrils. These fibrils are deposited in certain organs including the heart, eyes, digestive tract, nervous system, and kidneys. 3 There are two types of ATTR: a sporadic, non-genetic form known as wild-type ATTR (wtATTR) and a hereditary form (hATTR, also referred to as the variant form ATTRv) caused by pathogenic variants in the TTR gene inherited in an autosomal dominant (AD) manner. In patients with wtATTR, amyloid fibrils are deposited almost entirely in the myocardium, resulting in ATTR cardiomyopathy (ATTR-CM). 4,5 In contrast, hATTR may present as ATTR-CM, polyneuropathy (ATTR-PN), or a mixed phenotype of both through the deposition of the misfolded protein in both the cardiovascular and peripheral nervous systems. 3,6 The true prevalence of wtATTR is unknown; however autopsy studies have suggested that it is higher than previously recognized with some studies showing that ~25% of individuals 80 or older have wild-type fibrils, regardless of symptoms. 5,7-9 Historically, hATTR was thought to be endemic to certain regions including northern Portugal, northern Sweden and Japan with a prevalence of 1-10 per 10,000 individuals. However, to date the disorder has now been reported in multiple countries with an estimated global prevalence of 5000-40,000 individuals. 9-11
Diagnosis
Symptoms of patients with ATTR-CM include those commonly seen in heart failure including fatigue, exercise intolerance, palpitations, conduction abnormalities, and arrhythmias. 4,5 Other early indicator disease characteristics include elevated troponin or N-terminal pro-brain natriuretic peptide levels, an intolerance of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers, carpel tunnel syndrome (CTS), lumbar spinal stenosis, and biceps tendon rupture. 4,12,13 The age of onset of wtATTR-CM is generally above the age of 60, whereas that of hATTR-CM varies from 30-80 years old depending on the TTR variant. The median survival after diagnosis is ~3.5 and ~2.5 years respectively for wtATTR-CM and hATTR-CM. 4 The clinical presentation of patients with hATTR-PN is also variable with no specific signs or symptoms uniquely associated with the disease. However, a number of “red flags” have been identified that should raise suspicion. 14 Karam et al. reported that the most important features suggestive of hATTR are the rate of neuropathy progression and comorbidities such as gastrointestinal dysmotility, heart failure with preserved ejection fraction, autonomic failure and CTS. 15 For example, although common in the general population, CTS in patients with hATTR is more often bilateral, more prone to recurrence and more refractory to treatment. A family or personal history of idiopathic neuropathy that does not respond to treatments for other neuropathies or is rapidly progressing is also suggestive for hATTR.
The contractor cites 53 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2025-08-17
- Current revision effective
- 2026-02-05
- Last reviewed by the contractor
- 2025-06-23
- MCD version
- 7
Other related documents: A60201 (Response to Comments), A60202 (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 Noridian Healthcare Solutions, LLC 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 L39948 cover?
• Has at least one additional features suggestive of hATTR according to expert consensus and society guidelines. 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 L39948 apply to?
Noridian Healthcare Solutions, LLC applies it to Medicare claims in AK, AS, AZ, CA, CNMI, GU, HI, ID, MT, ND, NF, NV, OR, SD, SF, UT, WA, 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 L39948?
The companion billing and coding article A59872 lists 19 ICD-10-CM codes in 1 group that support medical necessity; the first 19 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L39948?
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.