News and trends on diagnostics testing, insurance coverage, and reimbursement.
A private payor survey by ClearView Healthcare Partners found that medical directors viewed CMS's decision with caution; half had no plans to align commercial plan coverage.
Under the draft determination, the test would be covered to help assess which treatments to use in patients with advanced prostate cancer.
The policy states that lab tests without FDA's blessing may pursue local coverage via Medicare contractors, but national coverage requires premarket approval or clearance.
The final determination also adds coverage for FDA-approved tests in stage III patients, and for repeat testing if patients receive a new primary diagnosis.
The lab industry's appeal to CMS follows Missouri's Medicaid agency's reduction of lab reimbursements from 100 percent to 80 percent of Medicare rates.