After a GAO report found that CMS may be overpaying for lab tests, the legislator is asking the government payor to explain how it will ensure appropriate use of taxpayer funds.
Data from the GUIDED study will be central to commercial payor discussions, a Medicare LCD reconsideration request, and eventually expansion into the primary care market.
In a letter to CMS, AMP made a case for crosswalking existing CPT codes for BRCA1/2 testing to codes that more accurately reflect the work required to analyze these genes.
Smaller labs that serve large Medicare populations, such as skilled nursing facility labs, have cut services and expressed concerns about their survival.
New drugs, tests, and policies suggest steady and continued future growth in the space, though public awareness of personalized medicine continues to lag.
The group recommends Myriad Genetics' EndoPredict, NanoString's Prosigna, and Genomic Health's Oncotype DX tests for guiding chemotherapy decisions if certain conditions are met.
A study of the detection of potential adverse drug events or interactions found that using PGx information led to better prediction of serious issues, despite no significant change overall.
The health insurer renewed its longstanding clinical lab services relationship with LabCorp and added Quest as an in-network provider of such services.
The unique, test-specific PLA codes make it easier for insurers to identify tests and apply positive or negative coverage policies, billing experts say.
The decision, issued by Medicare Administrative Contractor Palmetto GBA, is effective Dec. 10 and provides coverage of the test for about 25,000 Medicare patients.
Smaller multiplex molecular panels of five or fewer targets will be covered, while a determination of gastrointestinal panel coverage is expected soon.
