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The Medicare Administrative Contractor will provide limited coverage for the RNA gene expression test that helps rule out primary cutaneous melanoma.

The bipartisan bill is backed by more than 250 organizations, but ACMG remains opposed, arguing that ordering tests is part of the practice of medicine.

Medicare Administrative Contractor Palmetto released its final local coverage decision last year, and WPSIC has now aligned its coverage.

Scheduled to go into effect next year, CMS' price transparency regulations could drive down reimbursements but also streamline billing for hospital labs.

The final national coverage decision stipulates that NGS germline tests for assessing hereditary breast and ovarian cancer risk must have FDA's blessing.

A pair of lawyers familiar with the case said that while ACLA might not win the legal battle, its lawsuit could aid efforts to get a legal fix to the law.

Palmetto has expanded coverage of the ClonoSeq assay to include monitoring MRD testing for patients with chronic lymphocytic leukemia (CLL.)

The LCD for the RNA gene expression test will take effect on Feb. 10, 2020, the Medicare contractor said.

Despite the availability of more precision therapies and complex biomarker tests, systemic gaps and lack of physician education continued to hinder access.

While legislation and lawsuits sought to blunt PAMA's impact, labs also employed new technologies and strategies to cope with anticipated price cuts.

The bill, which will delay reporting of lab payment data required by PAMA, will now be passed on to the President, who is expected to sign it into law.

Efforts to pass a nationwide surprise billing law appear stalled for now, but state laws and proposals for federal legislation still loom large for labs.

The company's newest products and planned updates reveal a focus on operational efficiency and increasing automation for core lab management.  

 

While pass-through billing has long been a regular part of the lab landscape, some newer arrangements run afoul of payor policies and anti-kickback laws.

A bi-weekly listing of recent local coverage determinations from Medicare Administrative Contractors.

 

The LCD will provide coverage for the Decipher Prostate Biopsy genomic test for men with both favorable and unfavorable intermediate-risk prostate cancer. 

The test will now be considered medically reasonable and necessary for patients over 45 with moderately elevated levels of prostate-specific antigen. 

The insurer's move to equalize rates across all lab sites has particularly impacted hospital-based facilities, which have typically received higher reimbursement.

Medicare contractor Novitas has been considering a limited local coverage determination for the test, which calculates PSA values and determines whether a patient may need a prostate biopsy. 

Recent local coverage determinations from Medicare Administrative Contractors, posted Nov. 1, 2019.

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