After oncology, cardiology is a significant clinical area for genetic testing. Medicare programs have traditionally said fairly little about this. The Novitas MAC proposed a new LCD dedicated solely to cardiology testing. Stakeholders may want to comment.
The LCD exemplifies an important new trend - also seen in a currently proposed MolDx LCD for cancer inherited risk testing - of stating some generalities and principles of coverage but not stating any particular diseases, conditions, or genes covered. Those might be stated, or updated, in greater or lesser detail in accompanying articles, or, the LCD could be viewed as "self-implementing" when the generalities are complied with.
What's the Problem?
The difficulty is that the physicians and patients can't look up what is covered, or denied, in the viewpoint of the medical director or nursing staff later implementing the policy.
Further, it's difficult or impossible for Medicare Advantage plans to know what they must, or need not, comply with.
A few months ago Novitas issued a policy for molecular infectious disease testing that simply stated such testing was covered when it was timely and likely to influence care. Well, yes, but those are generalities that might lead into hostile arguments in event of an audit or recoupment.
More Detail - See Links & Comment
See the Novitas webpage for new LCDs here. The LCD for cardiovascular genetic testing is DL39082, and is paired with a billing article DA58795. Comment period is open July 29-September 11, 2021.
I've clipped the body of the LCD, as proposed, below the break.
I mentioned in the introduction that if Medicare MAC LCDs are vaguely written, it is hard for Medicare Advantage (MA) plans to translate them into coverage. A similar problem occurs where the Affordable Care Act requires commercial payors to translate USPSTF benefits - all of them - into coverage, as the language and style and logic of the USPTF documents don't necessarily crosswalk explicitly into the types of rules that payors use for coverage decisions.