Payor Coverage

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
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Quest launches long-COVID testing panels for consumers
Ohio, Kentucky doctors convicted in scheme to bill Medicaid for millions of dollars in unnecessary urinalysis testing
RNA-seq analysis links protein to spread of pancreatic cancer, reveals potential drug target
Patients prefer immediate test results, even when the news is bad
Point-of-care test developer Proxim Diagnostics obtains strategic investment from BioMérieux
Quest Diagnostics offers suite of services for transplant patients and living donors
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
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Immunovia nabs CMS preliminary payment determination
The CMS preliminary payment determination implied a test price of $897.
September 26, 2022
2022 07 08 16 10 0843 Research Money 400
ACLA campaign, letter seek to stop cuts in lab testing payments
ACLA said it is launching a series of digital advertisements as part of its Stop Lab Cuts campaign to urge Congress to pass the Saving Access to Laboratory Services Act.
September 12, 2022
2022 09 13 16 54 6353 Lab Vacutainer Test Tube 400
OncoCyte announces evaluation of gene expression test
In a clinical trial, 429 patients diagnosed with metastatic urothelial cancer were treated with atezolizumab (Tecentriq, Genentech), an immune checkpoint inhibitor.
August 24, 2022
2022 04 18 13 42 3384 Dna Genome Gene Targeted 400
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