In early June 2023, Novitas and First Coast introduced a new policy called the Genetic Testing for Oncology (L39365) Local Coverage Determination (LCD). This policy has raised concerns due to potential reimbursement challenges, which could lead to suspending payments for specific markers, particularly certain bladder markers, and excluding FISH testing from coverage. The possible implementation of this LCD could result in Medicare beneficiaries with cancer losing access to essential genetic tests, even tests that these contractors have covered historically.
The initial LCD was promulgated outside the typical (and required) consideration process and rescinded shortly after. However, the proposed policy guidelines were reissued a few weeks later alongside a comment period and an announcement of upcoming hearing dates, August 10th, and August 11th. In response, LUGPA, in collaboration with important partners including AUA and AACU, is actively engaging with the Medical Administrative Contractors (MACs). Our primary objective is to provide these contractors with a comprehensive understanding of the practical application of these tests in real clinical scenarios and their crucial role in patient care.
We are closely monitoring these unfolding events and will ensure that you remain informed about any further developments. Your engagement and support are crucial in advocating for equitable and well-informed decisions in Medicare coverage policies.
