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The classifiers are considered reasonable and necessary if the patient can tolerate chemotherapy and it's being considered as a treatment for the patient.
The MAC will consider PGx testing reasonable and necessary after a physician has narrowed a patient's treatment options to specific medications.
A bi-weekly listing of recent local coverage determinations from Medicare Administrative Contractors.
Under the LCD, pharmacogenomic tests are covered when medications are being considered for use that are known to have a clinically actionable gene-drug interaction.
The decision comes after Myriad requested expanded coverage for women with breast cancer seeking information about extending endocrine therapy.
The Medicare Administrative Contractor's decision covers molecular diagnostic laboratory tests as predictive classifiers for non-small cell lung cancer.
The PCR tests are being requested more often during the SARS-CoV-2 pandemic to rule out patients with other viral respiratory conditions.
The Medicare Administrative Contractor is aligning its coverage decision with Palmetto GBA's final decision and it will go into effect May 4.