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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 new rate applies to clinical diagnostic lab tests using high-throughput technologies that can process more than 200 specimens per day.
Under the guidance, group health plans and group and individual health insurers must cover diagnostic testing and other "certain related items and services."
The diagnostic will be covered when patients are tested according to the Japanese Organization of Hereditary Breast and Ovarian Cancer's criteria.
The lawsuit also alleges Anthem failed to delete inaccurate diagnosis codes, leading to inflated risk-adjustment payments from Medicare.
If the bill passes in its current form, PAMA reporting would be delayed until January 2022 and rate cuts scheduled for 2021 would be put off to 2022.
The reimbursement contract provides about 9 million additional men access to the urine-based, genomic EPI test, Bio-Techne said.
A pathologists' group has pointed out that the bill covers only EUA tests, and patients receiving tests with pending regulatory status may receive surprise bills.
The agency will reimburse at about $35.91 per test for CDC assays and about $51.31 per test for non-CDC assays.
The Medicare Administrative Contractor is aligning its coverage decision with Palmetto GBA's final decision and it will go into effect May 4.
The insurer will cover testing at the Rady Children's Institute for Genomic Medicine for children in intensive care with unexplained medical conditions.
The government payor is interested in public input on the evidence underlying the blood-based PCR test.
A bi-weekly listing of recent local coverage determinations from Medicare Administrative Contractors.
Aiming to improve patient access to critical drugs and tests, a group of legislators have started a caucus to shore up bipartisan support for personalized medicine.
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.