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Diagnostics Reimbursement News

Reimbursement news and insurance coverage updates.

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.