MolDx program’s proposed local coverage determination (LCD) would restrict the frequency of molecular surveillance testing for transplant rejection, setting limits substantially below current clinical recommendations—for example, capping kidney transplant surveillance at four tests in the first year versus CareDx's recommended 15. The draft also challenges the routine use of combined molecular assays like cfDNA and gene expression profiling, emphasizing the need for stronger evidence. These changes could halve CareDx's total addressable market. Meanwhile, Palmetto GBA declined coverage for molecular tests aiding radiation therapy decisions in ductal carcinoma in situ due to insufficient evidence. These evolving policies underscore tighter reimbursement scrutiny for precision diagnostics.