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Local Coverage Determinations Roundup: Natera, Veracyte, and Decipher

NEW YORK (GenomeWeb) – Medicare Administrative Contractors recently released a number of local coverage determinations (LCDs) to align their coverage terms with Plametto’s MolDx program.

Below is a list and brief description for each of the LCDs. Each listing starts with the Medicare contractor that made the decision.


Draft LCDs:

CGS Administrators: Natera’s Prospera Kidney Transplant Test**

The contractor aligned its draft coverage terms with Palmetto’s earlier proposed coverage decision for Prospera. The donor-derived cell-free DNA test is intended to be used with standard assessments to rule in or rule out kidney rejection in transplant patients and decide if a diagnostic biopsy is needed.

Final LCDs:

Noridian and CGS Administrators: Veracyte's Envisia Genomic Classifier**

The contractors issued coverage decisions (see here and here) in line with Palmetto's earlier final LCD to cover Veracyte's Envisia Genomic Classifier assay to clarify the diagnosis of patients with interstitial lung disease who are suspected of having idiopathic pulmonary fibrosis. Wisconsin Physicians Service Insurance Corporation issued similar coverage as well.

Noridian: Decipher Biosciences' Decipher Prostate Cancer Classifier**

The contractor issued a final LCD for the Decipher prostate cancer classifier for men who are deemed low risk and very low risk for prostate cancer by National Comprehensive Cancer Network’s guidelines when certain criteria are met. This aligns Noridian’s coverage for the test with Palmetto and other contractors' coverage policies.



**Palmetto administers the MolDX program, in which three other Medicare Administrative Contractors (MACs) participate, including Noridian, CGS, and Wisconsin Physicians Service Insurance Corporation. Each MAC issues its own draft and final policy to align with Palmetto’s coverage terms for a specific test.