PGDx receives updated Medicare rate for Elio test

LabPulse.com staff writers
Jan 27, 2022
2022 01 10 23 10 0651 Lab Test Tube Dna Blood 400

Personal Genome Diagnostics (PGDx) announced an updated Medicare reimbursement rate for the Elio tissue complete test, a comprehensive genomic profiling test for patients living with advanced cancers.

The Centers for Medicare & Medicaid Services finalized a national reimbursement rate of $2,919.60 for the proprietary laboratory analyses code (0250U) that PGDx obtained for the test, the company reported in a release.

The new Medicare payment rate went into effect on January 1, 2022, and more information can be found on the CMS lab fee schedule webpage.

Latest in Payor Coverage
Money Bag Grant Award Social
Report shows Medicare risked up to $888M in improper payments for molecular pathology test
June 23, 2023
Legal Letter Contract No Gavel Social
Patients concerned about Medicare policy that limits coverage of noninvasive post-transplant tests
May 12, 2023
Cancer Cells Prostate Social
MDxHealth nabs reimbursement for prostate cancer risk test
April 20, 2023
Money Hundred Bills Social
For 2016 and 2017, Geisinger received at least $6.5M in overpayments from CMS: HHS OIG report
March 20, 2023
Related Stories
2019 09 23 17 18 0797 Colon Intestine 400
Colorectal Cancer
Exact Sciences supports CMS screening policy changes
2019 04 22 23 41 4967 Cancer Cell Target2 400
Pathology, histology
PGDx raises $103M in financing
2019 05 28 19 27 1157 Approved Stamp 400
FDA Clearance
PGDx secures FDA clearance for tumor genomic profiling kit
2020 01 08 21 29 8936 Dna Sequencing Sanger 400
Collaboration
PGDx, Mayo Clinic collaborate on blood and tissue cancer tests
More in Payor Coverage
Report shows Medicare risked up to $888M in improper payments for molecular pathology test
The HHS Office of Inspector General analyzed Medicare Part B claims associated with payments for more than 450,000 genetic tests billed under Current Procedural Terminology (CPT) code 81408.
June 23, 2023
Money Bag Grant Award Social
Patients concerned about Medicare policy that limits coverage of noninvasive post-transplant tests
In a survey, 95% of patient participants said they believe that reduced coverage for noninvasive tests would negatively impact their post-transplant care.
May 12, 2023
Legal Letter Contract No Gavel Social
MDxHealth nabs reimbursement for prostate cancer risk test
The firm's Select mdx test will now be reimbursed in the U.S. for Medicare patients who meet coverage conditions under a specific, foundational Local Coverage Determination (LCD).
April 20, 2023
Cancer Cells Prostate Social
For 2016 and 2017, Geisinger received at least $6.5M in overpayments from CMS: HHS OIG report
Based on estimates, Geisinger received millions in overpayments for 2016 and 2017 but Geisinger also disagreed with almost all findings outlined in a draft report, OIG said.
March 20, 2023
Money Hundred Bills Social
DermTech obtains melanoma testing coverage for additional 1.9 million people
The skin-based genomics test is a noninvasive way to enhance melanoma detection with a greater than 99% negative predictive value, DermTech said.
March 7, 2023
Cutaneous Squamous Cell Carcinoma Skin Social
Medicare paid $704.2M for drug testing at risk of noncompliance with requirements
In an audit, the Office of Inspector General identified Medicare Part B payments for drug testing services that were at risk for noncompliance with Medicare requirements.
March 1, 2023
Money Hundred Bills Social
UnitedHealthcare increases coverage for Guardant360 CDx liquid biopsy test
The new policy coverage by UnitedHealthcare is in addition to coverage for the liquid biopsy CDx test under UHC Medicare Advantage policies for comprehensive genomic profiling of all solid tumors.
February 8, 2023
Business Deal Corporate Social
DermTech melanoma assay recommended for coverage by military healthcare program
DermTech said the coverage recommendation makes the assay available to Tricare’s approximately nine million members and beneficiaries of the U.S. military health system.
January 11, 2023
Insurance Computer Social
Aspira Women’s Health announces milestones for expanded access to ovarian cancer risk test
The 2023 Omnibus Spending Bill contains language directing CMS to cover multimarker tests for ovarian cancer, increasing access to this testing; the expansion could encourage commercial insurers to adopt similar coverage policies.
December 27, 2022
Ovarian Cancer Diagram Social
Medicare policy increases access to noninvasive colorectal cancer tests: Exact Sciences
CMS is expanding coverage for certain colorectal cancer screening tests by reducing the minimum age payment and coverage limitation from 50 to 45 years.
December 20, 2022
Colorectal Cancer Social
Biodesix nabs positive coverage decisions from four private payors
The firm’s Nodify XL2 test will now be covered for enrollees of Blue Cross of North Carolina, Blue Cross Blue Shield of South Carolina, Blue Cross Blue Shield of Kansas City, and Capital District Physician’s Health Plan (CDPHP) of New York.
December 19, 2022
Hands Shaking Deal Social
Cleveland Diagnostics nabs Medicare coverage for test that interrogates PSA structural variants
In large, prospective multicenter studies of men scheduled for biopsy, IsoPSA demonstrated greater diagnostic accuracy than PSA alone in identifying patients with high-grade cancer
October 13, 2022
Cancer Cells Prostate Social
Page 1 of 5
Next Page