Sunday, March 20, 2016

Noridian Finalizes and Activates the Lung Cancer Gene Panel LCD for California

Back in January 2015, over a year ago, the MolDX program publishes a limited coverage LCD for lung cancer gene panels, limited to light and non smokers and requiring some coverage with evidence reporting.  By summer and fall, more and more commercial carriers were providing similar coverage, based on recommendations for broader gene panels by major clinical associations.

In July 2015, the Noridian MAC published a corresponding MolDX LCD for J-E and J-F.  In February 2016, the LCD was finalized with no changes although a Q&A comment document was also published.  It will be active and effective in J-E and J-F in April 2016.  Links after the break.

As of March 2016, the original LCD was available here, the Q&A public comments document here, and the final LCD (active April 2016) here.   A cloud archive of the original LCD is here, a cloud archive of the Q&A here, and of the final LCD here.

An article on the original east coast MolDX LCD from January 2015 (here) and on the finalization in May 2015 (here) and the adoption of similar but not identical coverage by other MACs (here).

One variance between MolDX and the New England/NGS MAC is that the New England MAC appears to apply the standard CPT code 81445 to testing (paying about $600 on the 2016 Clinical Lab Fee Schedule) whereas MolDX has a policy that carves comprehensive genomic profiling out and away from 81445.  Instead of directing to 81445, the coding article for "comprehensive genomic profiling" requires this service to be billed under unlisted code 81479, and priced locally by MolDX.  (Discussion in this blog, December 2015, here , and in the Dark Report issue of February 29, 2016 [paper only, subscription only]).