Wednesday, March 21, 2018

A Flow Chart for Medicare's Final NCD for NGS Testing in Cancer

Here's my best version of a flow chart for Medicare's March 16, 2018, Final NCD for NGS Testing in Advanced Cancer. 

click to enlarge

Note that patients with non-advanced cancer have:
  • no NGS testing (neither NCD nor LCD) or 
  • alternatively can get LCD testing if the test is a "non-targeted-therapy test" (e.g. minimal residual disease tests), and this difference:
  • depending on a sentence on page 4 about the scope of the NCD.
In this sentence, CMS writes that the NCD applies only to NGS tests to choose targeted therapies or assign patients to targeted therapy trials

The LCD pathway is not specific for indication, though it is specific for advanced cancer and 1 use of a test.

The green boxes show the route to guaranteed NCD coverage:  NGS technology & patient has advanced cancer & test is FDA companion diagnostic & patient's cancer is on-label for test & patient has not had this test for this cancer before.

For my long article on implications of the NCD, see here.