CMS runs a database of national and local coverage decisions, which includes a "What's New" weekly update report for LCDs and Articles from MACs. This website lists both newly completed LCDs and newly proposed ones. Here.
I noted a flurry of MOLDX activity. Note that MolDx LCDs and articles appear at four different MACs (Palmetto, Noridian, CGS, WPS) and each has its own timing. For example, at one MAC a proposed LCD might appear two weeks later, so at that MAC its comment period runs two weeks later as well.
Here's a What's New listing, and I also put all the items into one Zip file in the cloud here.
- DL37725 - Melanoma Risk Stratification Molecular Testing.
- DL38966 - NGS LDTs for Inherited Cancer Syndromes.
- DL38988 - Multiplex NAAT Panels for Infectious Disease Testing
- DL38985 - Biomarkers to Risk-Stratify Patients for Prostate Cancer
- L38671 - Molecular Testing for Organ Allograft Rejection
- A58170, Billing and Coding for same, here.\
- Existing Allosure LCD L38255 has simultaneously been scheduled for Retirement on 6/5/2021. Here.
- L38645 - Phenotypic Biomarkers for Circulating Tumor Cells
Unlisted Codes - Limited Value for Public Health Researchers. While unlisted code use + Z codes are a key feature of MolDx claims processing, this does make it difficult for public health stakeholders and researchers to know year by year what tests for what purposes are being covered by Medicare; all the claims for different disorders and conditions aggregate under payments for code 81479. Among many others, groups that use CPT utilization to understand Medicare trends include Katherine Phillips' group at UCSF (e.g. here) or Peter Neumann's group at Tufts (e.g. here). You can count, study, and assess which Medicare patients got a tumor panel test if coded as 81455 or a PLA code, but not when coded as 8179 unlisted code. (Unlisted codes also circumvent the PAMA rate setting process entirely.)
Quite similarly, Novitas recently released a draft LCD that infectious disease panels are covered 'when they are timely and likely to influence care" - full stop. Again, very hard as a rule that Medicare Advantage plans must copy and audit to. (DL38916). And hard for labs to educate physicians in advance what is covered or not covered by their MAC.