Your Obesity Code Decides Whether the Liver Test Gets Paid
MolDX switched on coverage for MASLD and MASH fibrosis biomarker testing across seven MAC jurisdictions on August 10, at lab fee schedule rates running from $176.19 to $792.17 for one test per patient per year. The claim needs a diagnosis from each of two lists, and the list that grew from 17 codes to 108 between draft and final still leaves out morbid obesity and metabolic syndrome.
In March 2024 the FDA approved resmetirom, the first drug for MASH with moderate to advanced fibrosis, and the label did not require a liver biopsy to establish the stage. That left an obvious question for everyone who bills: what does the payer accept instead of the biopsy?
Two years and five months later, four Medicare contractors answered it in writing.
On August 10 a single MolDX policy took effect as four separate LCDs: L40187 at Palmetto GBA (JJ, JM), L40197 at Noridian (JE, JF), L40199 at CGS (J15) and L40272 at WPS (J5, J8). Same coverage text, same criteria, same seven codes, same notice period running June 25 through August 9. Seven A/B MAC jurisdictions turned on together.
The policy is MAC initiated, which means nobody in industry asked for it. And it is limited coverage, which is the phrase that should get your attention: the LCD's own Issue Description says so.
What Turned On, and What It Pays
Seven CPT and PLA codes sit on the billing article, identical across all four contractors. Five carry a published price and the spread between them is the whole story (chart below).
At the top, 0344U, the 28-lipid-marker panel, pays $792.17 on the CY2026 lab fee schedule. 0166U and 0003M, both ten-assay panels, pay $503.40, and 0468U pays $251.70.
At the bottom sits 81517, the three-biomarker serum test the LCD's own evidence section names by name as the guideline-endorsed alternative to imaging. It pays $176.19.
That is a 4.5x range, or $615.98 a test, for one covered service on one covered indication.
Run 500 covered tests a year and the code mix alone moves $307,990 across your top line, between $88,095 at the bottom of the list and $396,085 at the top. Nothing in the policy prefers one over another. Coverage is coverage.
The last two codes are 81479 and 81599, unlisted molecular pathology and unlisted multianalyte assay. Neither appears anywhere on the CY2026 CLFS. They are on a covered list with no published rate, which means contractor pricing, which means you find out what it pays when the remittance arrives.
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