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- Advocacy Win: Medicare Contractors Change Genetic Testing Coverage
Novitas and FCSO Medicare Administrative Contractors (MACs) have released their finalized "Genetic Testing for Oncology: Specific Tests" local coverage determinations (LCDs), L39365 and L39367, respectively.
After extensive advocacy efforts by the CAP and other stakeholders, changes have been made, including:
- The finalized policy no longer delegates coverage for genetic tests that are excluded from one of three knowledgebases (eg. NCCN guidelines, OncoKb, and ClinGen). However, the knowledgebases will continue to serve as evidence resources.
- In another notable change, the MACs removed the proposed limitation that Genetic tests for hereditary cancer syndromes included in the LCD could only be performed once per beneficiary’s lifecycle. The CAP successfully argued that the decision to retest a patient should be undertaken by treating providers who can best assess the incremental benefit of repeat testing for additional mutations. Additionally, as science advances and additional tests become available that help contribute to the management of patient care, the LCDs now allow repeat testing for hereditary cancer syndromes.
- The extremely narrow list of diagnostic codes used in billing have also been expanded.
The coverage policy is scheduled to take effect on April 24.