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Payor Coverage
CMS Medicare fee schedule includes blood tests for CRC screening
By
LabPulse.com staff writers
In the 2025 Medicare Physician Fee Schedule final rule, the U.S. Centers for Medicare and Medicaid Services (CMS) updated coverage for a complete colorectal cancer (CRC) screening to include Medicare-covered blood-based biomarker CRC screening tests.
November 5, 2024
Payer consolidation raises red flags for diagnostic testing, pathology leaders
By
Liz Carey
A new report from the U.S. Department of Health and Human Services Office of the Inspector General shows that Medicare administrative contractors do not always comply with Medicare payment policies.
October 23, 2024
Humana, UnitedHealthcare change Z-code requirements for molecular diagnostic test claims
By
LabPulse.com staff writers
Among the tests in focus are certain RNA- and DNA-based tests.
September 19, 2024
Bluebird Bio signs state Medicaid agreement for SCD gene therapy
By
LabPulse.com staff writers
Bluebird Bio has signed its first outcomes-based Medicaid agreement for its sickle-cell disease (SCD) gene therapy Lyfgenia with the state of Michigan.
March 11, 2024
Report shows Medicare risked up to $888M in improper payments for molecular pathology test
By
Leo O'Connor
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
Patients concerned about Medicare policy that limits coverage of noninvasive post-transplant tests
By
LabPulse.com staff writers
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
MDxHealth nabs reimbursement for prostate cancer risk test
By
LabPulse.com staff writers
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
For 2016 and 2017, Geisinger received at least $6.5M in overpayments from CMS: HHS OIG report
By
LabPulse.com staff writers
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
DermTech obtains melanoma testing coverage for additional 1.9 million people
By
LabPulse.com staff writers
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
Medicare paid $704.2M for drug testing at risk of noncompliance with requirements
By
LabPulse.com staff writers
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
UnitedHealthcare increases coverage for Guardant360 CDx liquid biopsy test
By
LabPulse.com staff writers
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
DermTech melanoma assay recommended for coverage by military healthcare program
By
LabPulse.com staff writers
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
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